Provider Demographics
NPI:1437374295
Name:MENTAL HEALTH ASSOCIATION OF LICKING COUNTY INC.
Entity Type:Organization
Organization Name:MENTAL HEALTH ASSOCIATION OF LICKING COUNTY INC.
Other - Org Name:MENTAL HEALTH AMERICA OF LICKING COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PADDY
Authorized Official - Middle Name:
Authorized Official - Last Name:KUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-788-0302
Mailing Address - Street 1:65 MESSIMER DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1874
Mailing Address - Country:US
Mailing Address - Phone:740-522-1341
Mailing Address - Fax:740-522-4464
Practice Address - Street 1:65 MESSIMER DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1874
Practice Address - Country:US
Practice Address - Phone:740-522-1341
Practice Address - Fax:740-522-4464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH10183Medicare UPIN