MEDICARE: A PLACE TO LAND PSYCHOTHERAPY SERVICES, 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1720968001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A PLACE TO LAND PSYCHOTHERAPY SERVICES, LLC

Provider Business Mailing Address
First Line	:	4559 N EDGEWOOD AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45232-1803
Country	:	US
Telephone Number	:	513-379-5173
Fax Number	:

Provider Business Practice Location Address
First Line	:	5332 RAPID RUN RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-4244
Country	:	US
Telephone Number	:	513-379-6173
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	OLIVIA ROSE CARROLL
Credential	:	LISW
Telephone Number	:	513-379-6173

Provider Enumeration Date	:	09/05/2025
Last Update Date	:	09/05/2025

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