MEDICARE: PURNA BEHAVIORAL HEALTH 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
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1770422552
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURNA BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	1182 SHARE DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45432-1741
Country	:	US
Telephone Number	:	937-503-9280
Fax Number	:

Provider Business Practice Location Address
First Line	:	1182 SHARE DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45432-1741
Country	:	US
Telephone Number	:	937-503-9280
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALEXIS TOMPKINS
Credential	:
Telephone Number	:	937-503-9280

Provider Enumeration Date	:	03/26/2026
Last Update Date	:	03/26/2026

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