Healthcare Provider Details

I. General information

NPI: 1487633194
Provider Name (Legal Business Name): BEN-EL CHILD AND FAMILY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 12/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 SCIOTO ST. SUITE 200
URBANA OH
43078
US

IV. Provider business mailing address

PO BOX 755
URBANA OH
43078
US

V. Phone/Fax

Practice location:
  • Phone: 937-652-4555
  • Fax: 937-652-4945
Mailing address:
  • Phone: 937-652-4555
  • Fax: 937-652-4945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0074
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. THAN JOHNSON
Title or Position: CEO
Credential:
Phone: 937-653-1320