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General NPI Number Information
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NPI Number | 1376431544
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Entity Type | Organization
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Legal Business Name | MONARCH: WINGS OF KYLA FOUNDATION
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Dates
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Enumeration Date | 06/26/2025
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 680 E MAIN ST
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City | JACKSON
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State | OH
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Zip | 45640-2152
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Country | US
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Telephone | 740-529-0141
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Fax | 740-577-3222
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Provider Business Mailing Address
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Address Line | 205 S BENNETT AVE
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City | JACKSON
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State | OH
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Zip | 45640-1905
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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 | OWNER/CEO/THERAPIST
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Name | ROXANNE LARRIGAN
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Credential | LPCC, LICDC, LSW
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Telephone | 740-529-0141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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