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General NPI Number Information
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NPI Number | 1891761250
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Entity Type | Organization
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Legal Business Name | COMMUNITY MENTAL HEALTH CENTER OF CLINTON COUNTY
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Dates
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Enumeration Date | 02/27/2006
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Last Update Date | 10/29/2010
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Provider Practice Location Address
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Address Line | 975 FUJITEC BLDG A SUITE 1
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City | LEBANON
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State | OH
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Zip | 45036
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Country | US
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Telephone | 513-228-7800
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Fax | 513-228-7848
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Provider Business Mailing Address
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Address Line | 975 FUJITEC BLDG A SUITE 1
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City | LEBANON
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State | OH
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Zip | 45036
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Country | US
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Telephone | 513-228-7800
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Fax | 513-228-7848
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | BRAD MCMONIGLE
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Credential | PCC
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Telephone | 513-228-7800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 83613
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 266
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License Number State | OH
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