=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801162748
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TINA KAMINSKY, PH.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2012
-----------------------------------------------------
Last Update Date | 03/26/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26 E HOLLISTER ST
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45219-1704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-621-5001
-----------------------------------------------------
Fax | 513-621-5008
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26 E HOLLISTER ST
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45219-1704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-621-5001
-----------------------------------------------------
Fax | 513-621-5008
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TINA KAMINSKY
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 513-621-5001
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number | 2763
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------