Healthcare Provider Details

I. General information

NPI: 1932992450
Provider Name (Legal Business Name): OHIO OCD AND ANXIETY TREATMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31905 JACKSON RD
MORELAND HILLS OH
44022-1707
US

IV. Provider business mailing address

2722 ERIE AVE STE 219 PMB 727103
CINCINNATI OH
45208-2154
US

V. Phone/Fax

Practice location:
  • Phone: 630-474-3272
  • 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

VIII. Authorized Official

Name: SPENCER R POTESTA
Title or Position: MEMBER
Credential:
Phone: 630-474-3272