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General NPI Number Information
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NPI Number | 1609719095
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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 | 04/11/2026
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Last Update Date | 04/11/2026
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Provider Practice Location Address
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Address Line | 15797 MENDON RD
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City | OHIO CITY
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State | OH
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Zip | 45874-9237
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Country | US
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Telephone | 419-362-5597
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Fax | 888-728-4024
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Provider Business Mailing Address
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Address Line | 15797 MENDON RD
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City | OHIO CITY
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State | OH
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Zip | 45874-9237
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Country | US
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Telephone | 419-362-5597
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Fax | 888-728-4024
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Authorized Official
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Title or Position | CEO
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Name | DR. THOMAS RUSSELL
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Credential | DNP, CNP, FNP, PMHNP
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Telephone | 419-362-5597
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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