MEDICARE: OCEAN 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	2084P0800X	Psychiatry Physician
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1942891494
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEAN BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	250 E 5TH ST FL 15
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-4119
Country	:	US
Telephone Number	:	919-332-8969
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 E 5TH ST FL 15
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-4119
Country	:	US
Telephone Number	:	919-332-8969
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JASON OCEAN
Credential	:	LCSW
Telephone Number	:	919-332-8969

Provider Enumeration Date	:	01/28/2021
Last Update Date	:	01/28/2021

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