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NPI Code Detail

MEDICARE: MENDED REEDS MENTAL HEALTH, INC.

MEDICARE: MENDED REEDS MENTAL HEALTH, INC.
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
1101YA0400XAddiction (Substance Use Disorder) Counselor0588OH
2101YM0800XMental Health Counselor0588OH
3101YP2500XProfessional Counselor0588OH
4103TC0700XClinical Psychologist0588OH
5104100000XSocial Worker0588OH
61041C0700XClinical Social Worker0588OH
7251B00000XCase Management Agency0588OH
8251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1801154950
Entity Type Code : Organization
Provider Name (Legal Business Name) : MENDED REEDS MENTAL HEALTH, INC.
Provider Business Mailing Address
First Line : PO BOX 108
Second Line :
City : IRONTON
State : OH
Zip : 45638-0108
Country : US
Telephone Number : 740-532-1613
Fax Number : 740-532-1715
Provider Business Practice Location Address
First Line : 700 PARK AVE
Second Line :
City : IRONTON
State : OH
Zip : 45638-1502
Country : US
Telephone Number : 740-532-1613
Fax Number : 740-532-1715
Authorized Official
Title or Position : BILLING CLERK
Name : MRS. ANNA DAVIS
Credential :
Telephone Number : 740-532-1613
Provider Enumeration Date : 04/26/2012
Last Update Date : 06/19/2012

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IRONTON, OH
45638-1502
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1114293842 — KRISTINA M BURNS LPCC-S, LICDC
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1407261977 — MENDED REEDS SERVICES, INC.
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700 PARK AVE
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45638-1502
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1730594219 — MENDED REEDS SERVICES, INC.
Practice Location Address:
700 PARK AVE
IRONTON, OH
45638-1502
Practice Phone: 740-532-1613
Practice Fax: 740-532-1715

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