Healthcare Provider Details

I. General information

NPI: 1518587997
Provider Name (Legal Business Name): OWLBRIDGE WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2020
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6730 ROOSEVELT AVE STE 201
MIDDLETOWN OH
45005-5730
US

IV. Provider business mailing address

6730 ROOSEVELT AVE STE 201
MIDDLETOWN OH
45005-5730
US

V. Phone/Fax

Practice location:
  • Phone: 513-279-8035
  • Fax: 513-318-7386
Mailing address:
  • Phone: 513-279-8035
  • Fax: 513-318-7386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. LAVINDA C MCAULIFFE
Title or Position: OWNER
Credential: PMHNP
Phone: 513-279-8035