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8080 Beckett Center Dr Ste 223 West Chester OH 45069-5037 | |
| (513) 642-9737 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 8080 Beckett Center Dr Ste 223, West Chester, Ohio |
| Authorized Official Name and Position | Leigh Ann Brock (OWNER) |
| Authorized Official Contact | 5136429737 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
7717 Black Squirrel Trl Hamilton OH 45011-8561 Ph: (513) 642-9737 | 8080 Beckett Center Dr Ste 223 West Chester OH 45069-5037 Ph: (513) 642-9737 |
| NPI Number | 1275279218 |
|---|---|
| Provider Enumeration Date | 05/11/2022 |
| Last Update Date | 11/05/2024 |
| Certification Date | 11/05/2024 |
| Medicare PECOS PAC ID | 9830624428 |
|---|---|
| Medicare Enrollment ID | O20241119003454 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275279218 | NPI | - | NPPES |
| 2102566 | Other | OH | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Leigh Brock |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1063948834 PECOS PAC ID: 2365977964 Enrollment ID: I20241119003716 |
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