Healthcare Provider Details

I. General information

NPI: 1467960237
Provider Name (Legal Business Name): JUSTIN J OCHMANEK CDCA, QMHS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7540 NEW WEST RD
TOLEDO OH
43617
US

IV. Provider business mailing address

7540 NEW WEST RD
TOLEDO OH
43617-4200
US

V. Phone/Fax

Practice location:
  • Phone: 866-203-0308
  • Fax:
Mailing address:
  • Phone: 866-203-0308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCDCA.165554
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: