| Sound Mind Behavioral Wellness, Llc | |
|
5726 Southwyck Blvd Ste 200-b Toledo OH 43614-1559 | |
| (567) 742-7930 | |
| (419) 867-0464 |
| Full Name | Sound Mind Behavioral Wellness, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 5726 Southwyck Blvd Ste 200-b, Toledo, Ohio |
| Authorized Official Name and Position | Michelle L. Williams (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 4196011406 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sound Mind Behavioral Wellness, Llc 5726 Southwyck Blvd Ste 200-b Toledo OH 43614-1559 Ph: (567) 742-7930 | Sound Mind Behavioral Wellness, Llc 5726 Southwyck Blvd Ste 200-b Toledo OH 43614-1559 Ph: (567) 742-7930 |
| NPI Number | 1043846165 |
|---|---|
| Provider Enumeration Date | 03/20/2020 |
| Last Update Date | 08/05/2022 |
| Certification Date | 08/05/2022 |
| Medicare PECOS PAC ID | 2961827233 |
|---|---|
| Medicare Enrollment ID | O20200803003365 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043846165 | NPI | - | NPPES |
| 0444405 | Medicaid | OH | |
| 0315327 | Medicaid | OH | |
| 01-8165 | Other | OH | OHIO MENTAL HEALTH & ADDICTION SERVICES |
| 0294590 | Medicaid | OH | |
| 0178465 | Medicaid | OH | |
| 0406325 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Latoya Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952726093 PECOS PAC ID: 5395066039 Enrollment ID: I20150605001182 |
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