| NPI | 1245307966 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANA D. KEATHLEY Credentialing Specialist 330-676-6826 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: OH 0227) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH 0227) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2007-10-23 |