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General NPI Number Information
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NPI Number | 1316609332
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Entity Type | Organization
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Legal Business Name | MODERN BEHAVIORAL HEALTH SOLUTIONS
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Dates
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Enumeration Date | 10/07/2021
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Last Update Date | 10/07/2021
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Provider Practice Location Address
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Address Line | 543 ASPEN GLEN DR APT 511
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City | CINCINNATI
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State | OH
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Zip | 45244-1885
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Country | US
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Telephone | 513-309-2383
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Fax |
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Provider Business Mailing Address
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Address Line | 543 ASPEN GLEN DR APT 511
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City | CINCINNATI
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State | OH
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Zip | 45244-1885
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Country | US
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Telephone | 513-309-2383
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | BRIAN MCKIBBEN
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Credential | LISW-S
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Telephone | 513-309-2383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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