Healthcare Provider Details

I. General information

NPI: 1982695706
Provider Name (Legal Business Name): MENTAL HEALTH SERVICES FOR CLARK CO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

474 N YELLOW SPRINGS STREET
SPRINGFIELD OH
45504-2463
US

IV. Provider business mailing address

474 N YELLOW SPRINGS STREET
SPRINGFIELD OH
45504-2463
US

V. Phone/Fax

Practice location:
  • Phone: 937-399-9500
  • Fax: 937-342-4242
Mailing address:
  • Phone: 937-399-9500
  • Fax: 937-342-4242

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 TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELLY L RIGGER
Title or Position: CEO
Credential:
Phone: 937-399-9500