Provider Demographics
NPI:1588821003
Name:CONSCIOUS LIVING CENTER INC
Entity Type:Organization
Organization Name:CONSCIOUS LIVING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:OOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:513-621-3600
Mailing Address - Street 1:114 WELLINGTON PL
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-1736
Mailing Address - Country:US
Mailing Address - Phone:513-621-3600
Mailing Address - Fax:513-621-3613
Practice Address - Street 1:114 WELLINGTON PL
Practice Address - Street 2:SUITE 2
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1736
Practice Address - Country:US
Practice Address - Phone:513-621-3600
Practice Address - Fax:513-621-3613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT 000900251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health