Healthcare Provider Details

I. General information

NPI: 1205640380
Provider Name (Legal Business Name): KUDOSE MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 03/20/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8945 BROOKSIDE AVE STE 202
WEST CHESTER OH
45069-7123
US

IV. Provider business mailing address

8945 BROOKSIDE AVE STE 202
WEST CHESTER OH
45069-7123
US

V. Phone/Fax

Practice location:
  • Phone: 513-914-3673
  • Fax:
Mailing address:
  • Phone: 513-914-3673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH FOX
Title or Position: OWNER
Credential: APRN, PMHNP-BC
Phone: 513-310-2342