=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033091384
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELINDA LONGWELL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2025
-----------------------------------------------------
Last Update Date | 07/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7590 TYLERS PLACE BLVD
-----------------------------------------------------
City | WEST CHESTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45069-6307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-714-3400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6372 HEDGEROW DR
-----------------------------------------------------
City | WEST CHESTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45069-1801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-302-2307
-----------------------------------------------------
Fax | 419-302-2307
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | APS.006501
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------