=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932992450
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OHIO OCD AND ANXIETY TREATMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2025
-----------------------------------------------------
Last Update Date | 05/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31905 JACKSON RD
-----------------------------------------------------
City | MORELAND HILLS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44022-1707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-474-3272
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2722 ERIE AVE STE 219 PMB 727103
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45208-2154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | SPENCER R POTESTA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 630-474-3272
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------