Healthcare Provider Details

I. General information

NPI: 1851190672
Provider Name (Legal Business Name): MAVERICK MENTAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 12/07/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7110 W CENTRAL AVE STE E
TOLEDO OH
43617-3115
US

IV. Provider business mailing address

7110 W CENTRAL AVE STE E
TOLEDO OH
43617-3115
US

V. Phone/Fax

Practice location:
  • Phone: 419-266-5251
  • Fax: 419-754-2306
Mailing address:
  • Phone: 419-266-5251
  • Fax: 419-754-2306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. AMANDA SEABOLT
Title or Position: OWNER
Credential: PH.D.
Phone: 419-266-5251