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General NPI Number Information
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NPI Number | 1730846478
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Entity Type | Organization
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Legal Business Name | MAHOGANY BRIDGES MENTAL HEALTH SERVICES LLC
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Dates
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Enumeration Date | 11/17/2021
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Last Update Date | 11/17/2021
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Provider Practice Location Address
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Address Line | 2555 SOUTH DIXIE DRIVE SUITE 102
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City | DAYTON
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State | OH
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Zip | 45409
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Country | US
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Telephone | 330-518-2888
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Fax |
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Provider Business Mailing Address
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Address Line | 743 KNICKERBOCKER AVE
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City | SPRINGFIELD
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State | OH
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Zip | 45506-3319
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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 | MRS. MARQUITA THOMPSON
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Credential |
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Telephone | 330-518-2888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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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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