MEDICARE: SIRONA MENTAL WELLNESS, LLC

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	101YM0800X	Mental Health Counselor
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1437840808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIRONA MENTAL WELLNESS, LLC

Provider Business Mailing Address
First Line	:	3587 LEES FORD LN
Second Line	:
City	:	HAMILTON
State	:	OH
Zip	:	45011-2103
Country	:	US
Telephone Number	:	513-593-6601
Fax Number	:

Provider Business Practice Location Address
First Line	:	8200 BECKETT PARK DR
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-9310
Country	:	US
Telephone Number	:	513-991-7007
Fax Number	:	513-609-4558

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	CATHLEEN MCKNIGHT
Credential	:
Telephone Number	:	513-593-6601

Provider Enumeration Date	:	05/17/2023
Last Update Date	:	05/17/2023

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