Healthcare Provider Details

I. General information

NPI: 1811920697
Provider Name (Legal Business Name): DARKE COUNTY MENTAL HEALTH CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 E MAIN ST
GREENVILLE OH
45331-1913
US

IV. Provider business mailing address

PO BOX 895
GREENVILLE OH
45331-1913
US

V. Phone/Fax

Practice location:
  • Phone: 937-548-1635
  • Fax: 937-548-1500
Mailing address:
  • Phone: 937-548-1635
  • Fax: 937-548-1500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA K. MOORE
Title or Position: PRESIDENT - BOARD OF DIRECTORS
Credential:
Phone: 937-548-6842