Provider Demographics
NPI:1568767481
Name:MYLO JENNINGS & ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MYLO JENNINGS & ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MYLO
Authorized Official - Middle Name:G
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:419-691-8500
Mailing Address - Street 1:2737 NAVARRE AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3298
Mailing Address - Country:US
Mailing Address - Phone:419-691-8500
Mailing Address - Fax:419-691-8500
Practice Address - Street 1:2737 NAVARRE AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3298
Practice Address - Country:US
Practice Address - Phone:419-691-8500
Practice Address - Fax:419-691-8500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI8633-S1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty