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11085 Montgomery Rd Ste 250 Cincinnati OH 45249-2395 | |
| (513) 547-2861 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 11085 Montgomery Rd Ste 250, Cincinnati, Ohio |
| Authorized Official Name and Position | Nathan Fite (CLINICAL DIRECTOR AND OWNER) |
| Authorized Official Contact | 5133198062 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
11085 Montgomery Rd Ste 250 Cincinnati OH 45249-2395 Ph: (513) 547-2861 | 11085 Montgomery Rd Ste 250 Cincinnati OH 45249-2395 Ph: (513) 547-2861 |
| NPI Number | 1881208189 |
|---|---|
| Provider Enumeration Date | 09/03/2020 |
| Last Update Date | 04/30/2024 |
| Certification Date | 04/30/2024 |
| Medicare PECOS PAC ID | 2668915059 |
|---|---|
| Medicare Enrollment ID | O20240613001562 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881208189 | NPI | - | NPPES |
| 1356856231 | Medicaid | KS | |
| 1114378890 | Medicaid | OH | |
| 1467905778 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Stephanie Visjager |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154839322 PECOS PAC ID: 8224423124 Enrollment ID: I20220310002771 |
| Provider Name | Nathan Michael Fite |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1356856231 PECOS PAC ID: 4385187772 Enrollment ID: I20240729003074 |
| Provider Name | Katherine Curtis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114588506 PECOS PAC ID: 4981939709 Enrollment ID: I20240910002298 |
| Provider Name | Taylor Joy Evans |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124807052 PECOS PAC ID: 1951841428 Enrollment ID: I20240911000910 |
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