| State Of Ohio | |
|
1580 State Route 56 Sw London Correctional Institution London OH 43140-8623 | |
| (740) 852-2454 | |
| Not Available |
| Full Name | State Of Ohio |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1580 State Route 56 Sw, London, Ohio |
| Authorized Official Name and Position | Princess Cripe (STAFF PSYCHOLOGIST) |
| Authorized Official Contact | 7408522454 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| State Of Ohio 1049 Seacove Cir Apt. G London OH 43140-9134 Ph: (740) 852-2454 | State Of Ohio 1580 State Route 56 Sw London Correctional Institution London OH 43140-8623 Ph: (740) 852-2454 |
| NPI Number | 1902218779 |
|---|---|
| Provider Enumeration Date | 05/28/2014 |
| Last Update Date | 05/28/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902218779 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 6854 (Ohio) | Primary |
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