Healthcare Provider Details

I. General information

NPI: 1083215131
Provider Name (Legal Business Name): WARREN COUNTY ESC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1879 DEERFIELD RD
LEBANON OH
45036-8602
US

IV. Provider business mailing address

1879 DEERFIELD RD
LEBANON OH
45036-8602
US

V. Phone/Fax

Practice location:
  • Phone: 513-695-2900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JESSICA WOODY
Title or Position: LEAD MENTAL HEALTH THERAPIST
Credential: LPCC-S
Phone: 513-695-2900