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3865 Golden Meadow Ct Amelia OH 45102-2635 | |
| (562) 265-8222 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 3865 Golden Meadow Ct, Amelia, Ohio |
| Authorized Official Name and Position | Malisa Komolthiti (DIRECTOR) |
| Authorized Official Contact | 5622658222 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3865 Golden Meadow Ct Amelia OH 45102-2635 Ph: (562) 265-8222 | 3865 Golden Meadow Ct Amelia OH 45102-2635 Ph: (562) 265-8222 |
| NPI Number | 1023760691 |
|---|---|
| Provider Enumeration Date | 01/24/2022 |
| Last Update Date | 10/30/2024 |
| Certification Date | 10/30/2024 |
| Medicare PECOS PAC ID | 7315471331 |
|---|---|
| Medicare Enrollment ID | O20241113004557 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023760691 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Malisa Komolthiti |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1598394009 PECOS PAC ID: 4587000328 Enrollment ID: I20241113004567 |
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