Healthcare Provider Details

I. General information

NPI: 1861114712
Provider Name (Legal Business Name): MASSIVE MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 E KEMPER RD STE 4420B
SPRINGDALE OH
45246-5101
US

IV. Provider business mailing address

1329 E KEMPER RD STE 4220B
SPRINGDALE OH
45246-5100
US

V. Phone/Fax

Practice location:
  • Phone: 513-790-4367
  • Fax: 513-572-7142
Mailing address:
  • Phone:
  • Fax:

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: LADY CHRISTINE CROCKETT
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 513-790-4367