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General NPI Number Information
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NPI Number | 1912078312
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Entity Type | Organization
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Legal Business Name | PSYCHIATRIC HEALTH 1, LTD
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Dates
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Enumeration Date | 11/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 573 BROOKOVER AVE
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City | ZANESVILLE
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State | OH
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Zip | 43701-2101
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Country | US
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Telephone | 740-450-7620
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Fax | 740-450-7618
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Provider Business Mailing Address
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Address Line | 573 BROOKOVER AVE
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City | ZANESVILLE
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State | OH
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Zip | 43701-2101
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Country | US
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Telephone | 740-450-7620
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Fax | 740-450-7618
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Authorized Official
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Title or Position | OWNER PROVIDER
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Name | GEORGE T MOSES
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Credential | D.O
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Telephone | 740-450-7620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 34007515M
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License Number State | OH
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