Healthcare Provider Details

I. General information

NPI: 1417948407
Provider Name (Legal Business Name): MENTAL HEALTH SERVICES FOR CLARK CO INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

474 NORTH YELLOW SPRINGS STREET
SPRINGFIELD OH
45504-2463
US

IV. Provider business mailing address

474 NORTH YELLOW SPRINGS STREET
SPRINGFIELD OH
45504
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 TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberPPH-05-2406
License Number StateOH

VIII. Authorized Official

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