Provider Demographics
NPI:1245400993
Name:MENTAL HEALTH SERVICES FOR CLARK AND MADISON CO
Entity Type:Organization
Organization Name:MENTAL HEALTH SERVICES FOR CLARK AND MADISON CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:937-399-9500
Mailing Address - Street 1:1345 N FOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-1422
Mailing Address - Country:US
Mailing Address - Phone:937-399-9500
Mailing Address - Fax:937-399-2701
Practice Address - Street 1:1345 N FOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-1422
Practice Address - Country:US
Practice Address - Phone:937-399-9500
Practice Address - Fax:937-399-2701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH006251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2485716OtherMEDICAID RISPERDAL BILL