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General NPI Number Information
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NPI Number | 1245917392
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Entity Type | Organization
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Legal Business Name | CONNECTING HEMISPHERES BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 06/30/2023
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Last Update Date | 06/30/2023
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Provider Practice Location Address
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Address Line | 40 W 4TH ST STE 114
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City | MANSFIELD
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State | OH
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Zip | 44902-1206
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Country | US
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Telephone | 614-374-8865
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Fax | 949-695-2511
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Provider Business Mailing Address
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Address Line | PO BOX 9031
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City | LEXINGTON
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State | OH
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Zip | 44904-9031
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NP
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Name | HEATHER STEWART-MODIC
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Credential |
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Telephone | 614-374-8865
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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