=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669730487
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEFFERSON BEHAVIORAL HEALTH SYSTEM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2012
-----------------------------------------------------
Last Update Date | 04/30/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3200 JOHNSON RD
-----------------------------------------------------
City | STEUBENVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43952-2363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-264-7751
-----------------------------------------------------
Fax | 740-264-2422
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3200 JOHNSON RD
-----------------------------------------------------
City | STEUBENVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43952-2363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-264-7751
-----------------------------------------------------
Fax | 740-264-2422
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ANTHONY J SHEPOSH
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 740-264-7751
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 1310
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------