| NPI | 1134296213 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANA D. KEATHLEY Credentialing Specialist 330-676-6875 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: OH 0227) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH 0277) |
| 101YM0800X Counselor, Mental Health (Licence: OH 0277) | |
| 103TC0700X Psychologist, Clinical (Licence: OH 0277) | |
| 103TC1900X Psychologist, Counseling (Licence: OH 0277) | |
| 104100000X Social Worker (Licence: OH 0227) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 0277) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2017-01-05 |