Healthcare Provider Details

I. General information

NPI: 1366294456
Provider Name (Legal Business Name): PEER SOLUTIONS RECOVERY OHIO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 PIKE ST
MARIETTA OH
45750-3522
US

IV. Provider business mailing address

1017 PIKE ST
MARIETTA OH
45750-3522
US

V. Phone/Fax

Practice location:
  • Phone: 740-371-7007
  • Fax:
Mailing address:
  • Phone: 740-371-7007
  • Fax:

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 State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MERIAH WALTERS
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 740-371-7007