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General NPI Number Information
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NPI Number | 1598723728
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Entity Type | Organization
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Legal Business Name | MOUNDBUILDERS GUIDANCE CENTER, INC.
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 05/09/2008
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Provider Practice Location Address
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Address Line | 8402 BLACKJACK ROAD EXT
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City | MOUNT VERNON
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State | OH
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Zip | 43050-9193
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Country | US
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Telephone | 740-397-0442
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Fax | 740-392-1814
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Provider Business Mailing Address
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Address Line | 8402 BLACKJACK ROAD EXT
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City | MOUNT VERNON
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State | OH
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Zip | 43050-9193
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Country | US
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Telephone | 740-397-0442
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Fax | 740-392-1814
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Authorized Official
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Title or Position | CEO
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Name | MR. PATRICK C EVANS
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Credential |
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Telephone | 740-788-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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