MEDICARE: ROAD LESS TRAVELED BEHAVIORAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1063055382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROAD LESS TRAVELED BEHAVIORAL

Provider Business Mailing Address
First Line	:	2200 VICTORY PKWY STE 602
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-2837
Country	:	US
Telephone Number	:	513-614-0407
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 VICTORY PKWY STE 602
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-2837
Country	:	US
Telephone Number	:	513-614-0407
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID ROBY
Credential	:
Telephone Number	:	513-257-3207

Provider Enumeration Date	:	10/18/2019
Last Update Date	:	10/18/2019

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Directions to “ROAD LESS TRAVELED BEHAVIORAL ” Practice Location

Language	Start Address	Practice Location

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