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General NPI Number Information
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NPI Number | 1285985937
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Entity Type | Organization
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Legal Business Name | CSW BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 09/20/2012
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Last Update Date | 09/20/2012
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Provider Practice Location Address
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Address Line | 1320 WOODMAN DR
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City | DAYTON
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State | OH
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Zip | 45432-3497
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Country | US
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Telephone | 937-751-6639
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Fax | 937-424-0279
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Provider Business Mailing Address
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Address Line | 1320 WOODMAN DR
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City | DAYTON
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State | OH
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Zip | 45432-3497
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Country | US
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Telephone | 937-751-6639
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Fax | 937-424-0279
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Authorized Official
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Title or Position | DESIGNATED AGENT
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Name | TANYA GARD
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Credential |
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Telephone | 937-751-6639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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