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General NPI Number Information
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NPI Number | 1356955710
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Entity Type | Organization
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Legal Business Name | MODE BEHAVIORAL THERAPY, LLC
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Dates
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Enumeration Date | 09/03/2020
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 1329 E KEMPER RD STE 4220A
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City | CINCINNATI
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State | OH
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Zip | 45246-5100
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Country | US
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Telephone | 513-970-9522
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Fax | 513-436-0687
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Provider Business Mailing Address
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Address Line | 1329 E KEMPER RD STE 4220A
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City | SPRINGDALE
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State | OH
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Zip | 45246-5100
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Country | US
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Telephone | 513-970-9522
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LISA ZITO
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Credential | LISW-S, CDCA
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Telephone | 513-970-9522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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