Provider Demographics
NPI:1619941051
Name:MENTAL HEALTH SERVICES FOR CLARK AND MADISON COUNTIES, INC.
Entity Type:Organization
Organization Name:MENTAL HEALTH SERVICES FOR CLARK AND MADISON COUNTIES, INC.
Other - Org Name:MENTAL HEALTH SERVICES FOR MADISON COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:937-399-9500
Mailing Address - Street 1:210 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-1115
Mailing Address - Country:US
Mailing Address - Phone:740-852-6256
Mailing Address - Fax:740-852-6395
Practice Address - Street 1:210 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-1115
Practice Address - Country:US
Practice Address - Phone:740-852-6256
Practice Address - Fax:740-852-6395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6910OtherMACSIS