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General NPI Number Information
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NPI Number | 1578936746
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Entity Type | Organization
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Legal Business Name | MID-OHIO BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 11/09/2015
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Last Update Date | 05/26/2022
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Provider Practice Location Address
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Address Line | 930 BETHESDA DR UNIT 4
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City | ZANESVILLE
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State | OH
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Zip | 43701-0815
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Country | US
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Telephone | 740-569-5737
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Fax | 740-569-5716
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Provider Business Mailing Address
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Address Line | 7300 STONE GATE DR
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City | NEW ALBANY
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State | OH
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Zip | 43054-8193
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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 | MR. RUSS VALENTINE
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Credential |
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Telephone | 740-260-2068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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