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1205784683 NPI number — MENTARA BEHAVIORAL AND RECOVERY SERVICES

NPI Number: 1205784683
Health Care Provider/Practitioner: MENTARA BEHAVIORAL AND RECOVERY SERVICES

Information about “1205784683” NPI (MENTARA BEHAVIORAL AND RECOVERY SERVICES) exists in 1205784683 in HTML format HTML  |  1205784683 in plain Text format TXT  |  1205784683 in PDF (Portable Document Format) PDF  |  1205784683 in an XML format XML  formats.

NPI Number : 1205784683 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1205784683",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "MENTARA BEHAVIORAL AND RECOVERY SERVICES",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2109 CLOVERFERN WAY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HASLET",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "76052-1919",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "614-258-2270",
    "MailingAddressFaxNumber": "614-808-4695",
    "FirstLinePracticeLocationAddress": "810 KIMBALL PL",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COLUMBUS",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "43205-2813",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "614-258-2270",
    "PracticeLocationAddressFaxNumber": "614-808-4695",
    "EnumerationDate": "03/20/2026",
    "LastUpdateDate": "03/20/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BAILEY",
    "AuthorizedOfficialFirstName": "PATRICIA",
    "AuthorizedOfficialMiddleName": "D",
    "AuthorizedOfficialTitle": "MENTAL HEALTH NURSE PRACTITIONER",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PMHNP-BC",
    "AuthorizedOfficialTelephoneNumber": "614-296-4941",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2084P0800X",
        "TaxonomyName": "Psychiatry Physician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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