MEDICARE: MAVERICK MENTAL HEALTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0850X	Adult Mental Health Clinic/Center
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851190672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAVERICK MENTAL HEALTH, LLC

Provider Business Mailing Address
First Line	:	7110 W CENTRAL AVE STE E
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43617-3115
Country	:	US
Telephone Number	:	419-266-0072
Fax Number	:	419-754-2306

Provider Business Practice Location Address
First Line	:	7110 W CENTRAL AVE STE E
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43617-3115
Country	:	US
Telephone Number	:	419-266-0072
Fax Number	:	419-754-2306

Authorized Official
Title or Position	:	OWNER
Name	:	DR. AMANDA SEABOLT
Credential	:	PH.D.
Telephone Number	:	419-266-5251

Provider Enumeration Date	:	03/12/2025
Last Update Date	:	01/11/2026

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Directions to “MAVERICK MENTAL HEALTH, LLC ” Practice Location

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