Provider Demographics
NPI:1417509555
Name:OHIO VALLEY MINDHEALTH LLC
Entity Type:Organization
Organization Name:OHIO VALLEY MINDHEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAVENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCULLUM
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:812-706-9224
Mailing Address - Street 1:6400 PFAFFLIN LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-1826
Mailing Address - Country:US
Mailing Address - Phone:812-706-9224
Mailing Address - Fax:
Practice Address - Street 1:6400 PFAFFLIN LAKE BLVD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-1826
Practice Address - Country:US
Practice Address - Phone:812-706-9224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-09
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Multi-Specialty