Provider Demographics
NPI:1235693623
Name:EYES ON THERAPY
Entity Type:Organization
Organization Name:EYES ON THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:AIZHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KYDYKEEVA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:513-290-8417
Mailing Address - Street 1:1207 N PLUM ST STE A
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-1865
Mailing Address - Country:US
Mailing Address - Phone:513-290-8417
Mailing Address - Fax:
Practice Address - Street 1:1207 N PLUM ST STE A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-1865
Practice Address - Country:US
Practice Address - Phone:513-290-8417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)