MEDICARE: INTRINSIC PROMISE COMMUNITY MENTAL HEALTH

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1770420457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTRINSIC PROMISE COMMUNITY MENTAL HEALTH

Provider Business Mailing Address
First Line	:	3442 RIVERSIDE DR
Second Line	:
City	:	UPPER ARLINGTON
State	:	OH
Zip	:	43221-1743
Country	:	US
Telephone Number	:	614-352-2379
Fax Number	:	614-352-2379

Provider Business Practice Location Address
First Line	:	3442 RIVERSIDE DR
Second Line	:
City	:	UPPER ARLINGTON
State	:	OH
Zip	:	43221-1743
Country	:	US
Telephone Number	:	614-352-2379
Fax Number	:	614-352-2379

Authorized Official
Title or Position	:	OWNER/CLINICAL DIRECTOR
Name	:	DEMETRA T TAYLOR
Credential	:	PHD, LPCC
Telephone Number	:	614-859-0213

Provider Enumeration Date	:	05/01/2026
Last Update Date	:	05/01/2026

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