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General NPI Number Information
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NPI Number | 1679828073
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Entity Type | Organization
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Legal Business Name | MINDFUL YOUTH
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Dates
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Enumeration Date | 07/22/2012
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Last Update Date | 07/22/2012
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Provider Practice Location Address
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Address Line | 1026 DELTA AVE STE B
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City | CINCINNATI
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State | OH
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Zip | 45208-3163
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Country | US
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Telephone | 513-550-0776
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 141382
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City | CINCINNATI
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State | OH
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Zip | 45250-1382
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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 | PRESIDENT
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Name | MR. JOHN ORR
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Credential | LPCC
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Telephone | 513-550-0776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | E.0900032
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License Number State | OH
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