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General NPI Number Information
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NPI Number | 1225260888
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Entity Type | Organization
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Legal Business Name | MODERN PSYCHIATRY AND WELLNESS LLC
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Dates
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Enumeration Date | 08/17/2009
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Last Update Date | 10/27/2020
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Provider Practice Location Address
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Address Line | 1910 FAIRGROVE AVE STE E
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City | HAMILTON
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State | OH
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Zip | 45011-1930
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Country | US
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Telephone | 513-795-7557
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Fax | 513-297-7577
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Provider Business Mailing Address
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Address Line | 1910 FAIRGROVE AVE STE E
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City | HAMILTON
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State | OH
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Zip | 45011-1930
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Country | US
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Telephone | 513-795-7557
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Fax | 513-297-7577
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Authorized Official
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Title or Position | CEO
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Name | DR. QUINTON MOSS
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Credential | MD
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Telephone | 513-868-0055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State | OH
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