Healthcare Provider Details

I. General information

NPI: 1811736804
Provider Name (Legal Business Name): UNITY BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1632 E PERRY ST
PORT CLINTON OH
43452-1332
US

IV. Provider business mailing address

1632 E PERRY ST
PORT CLINTON OH
43452-1332
US

V. Phone/Fax

Practice location:
  • Phone: 419-960-5559
  • 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 Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: ALICIA BOREMAN
Title or Position: CHIEF OPERATIONS OFFICER
Credential: LPCC-S
Phone: 419-819-8428