Provider Demographics
NPI:1477673697
Name:MIDWEST BEHAVIORAL CARE
Entity Type:Organization
Organization Name:MIDWEST BEHAVIORAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KUEHNL-WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:937-454-0092
Mailing Address - Street 1:3821 LITTLE YORK RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-2409
Mailing Address - Country:US
Mailing Address - Phone:937-454-0092
Mailing Address - Fax:937-264-1101
Practice Address - Street 1:14 REMICK BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-9168
Practice Address - Country:US
Practice Address - Phone:937-454-0092
Practice Address - Fax:937-264-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty