Basic Information
| Provider Information | |||||||||
| NPI: | 1417157744 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DARKE COUNTY MENTAL HEALTH CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 212 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453311913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375481635 | ||||||||
| FaxNumber: | 9375481500 | ||||||||
| Practice Location | |||||||||
| Address1: | 212 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453311913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375481635 | ||||||||
| FaxNumber: | 9375481500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2007 | ||||||||
| LastUpdateDate: | 07/24/2007 | ||||||||
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| AuthorizedOfficialLastName: | MOORE | ||||||||
| AuthorizedOfficialFirstName: | JMAES | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9375481635 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PSYD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | S0008198 | OH | Y | Agencies | Community/Behavioral Health |
No ID Information.