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General NPI Number Information
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NPI Number | 1861114712
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Entity Type | Organization
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Legal Business Name | MASSIVE MENTAL HEALTH SERVICES
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Dates
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Enumeration Date | 09/16/2022
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 1329 E KEMPER RD STE 4420B
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City | SPRINGDALE
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State | OH
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Zip | 45246-5101
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Country | US
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Telephone | 513-790-4367
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Fax | 513-572-7142
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Provider Business Mailing Address
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Address Line | 1329 E KEMPER RD STE 4220B
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City | SPRINGDALE
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State | OH
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Zip | 45246-5100
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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 | CHIEF EXECUTIVE OFFICER
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Name | LADY CHRISTINE CROCKETT
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Credential |
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Telephone | 513-790-4367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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