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General NPI Number Information
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NPI Number | 1417864877
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Entity Type | Organization
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Legal Business Name | BEACON MENTAL HEALTH ASSOCIATES OF VAN WERT L.L.C.
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Dates
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Enumeration Date | 08/24/2026
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Last Update Date | 08/24/2026
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Provider Practice Location Address
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Address Line | 850 EUCLID AVE STE 8196798
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City | CLEVELAND
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State | OH
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Zip | 44114-3306
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Country | US
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Telephone | 419-362-5597
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Fax |
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Provider Business Mailing Address
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Address Line | 850 EUCLID AVE STE 8196798
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City | CLEVELAND
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State | OH
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Zip | 44114-3306
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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 | CEO
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Name | THOMAS RUSSELL
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Credential | DNP, CNP, FNP, PMHNP
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Telephone | 419-406-0067
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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