Healthcare Provider Details

I. General information

NPI: 1225260888
Provider Name (Legal Business Name): MODERN PSYCHIATRY AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2009
Last Update Date: 10/27/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 FAIRGROVE AVE STE E
HAMILTON OH
45011-1930
US

IV. Provider business mailing address

1910 FAIRGROVE AVE STE E
HAMILTON OH
45011-1930
US

V. Phone/Fax

Practice location:
  • Phone: 513-795-7557
  • Fax: 513-297-7577
Mailing address:
  • Phone: 513-795-7557
  • Fax: 513-297-7577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateOH

VIII. Authorized Official

Name: DR. QUINTON MOSS
Title or Position: CEO
Credential: MD
Phone: 513-868-0055