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General NPI Number Information
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NPI Number | 1417311473
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Entity Type | Organization
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Legal Business Name | MONTGOMERY COUNTY BOARD OF DEVELOPMENTAL DISABILITIES
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Dates
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Enumeration Date | 04/06/2016
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Last Update Date | 04/06/2016
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Provider Practice Location Address
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Address Line | 580 CALUMET LN
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City | DAYTON
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State | OH
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Zip | 45417-8014
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Country | US
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Telephone | 937-457-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 160 COPPERFIELD DR
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City | DAYTON
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State | OH
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Zip | 45415-1263
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Country | US
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Telephone | 937-475-1734
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST
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Name | MRS. CORTNEY MARIE BANKS
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Credential | MS, LPC
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Telephone | 937-457-2870
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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 | C.1001000
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License Number State | OH
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