Healthcare Provider Details

I. General information

NPI: 1326453127
Provider Name (Legal Business Name): SAMANTHA MCGRAW QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2014
Last Update Date: 07/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

953 S SOUTH ST
WILMINGTON OH
45177-2921
US

IV. Provider business mailing address

975 KINGSVIEW DR SUITE 400
LEBANON OH
45036-9562
US

V. Phone/Fax

Practice location:
  • Phone: 937-383-4441
  • Fax: 937-383-2921
Mailing address:
  • Phone: 513-228-7854
  • Fax: 513-228-7848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberQMHP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: