Provider Demographics
NPI:1811204977
Name:MINORITY BEHAVIORAL HEALTH GROUP
Entity Type:Organization
Organization Name:MINORITY BEHAVIORAL HEALTH GROUP
Other - Org Name:MBHG
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILMORE-STROUD
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:330-374-1199
Mailing Address - Street 1:1293 COPLEY RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-2766
Mailing Address - Country:US
Mailing Address - Phone:330-374-1199
Mailing Address - Fax:330-374-0151
Practice Address - Street 1:1293 COPLEY RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-2766
Practice Address - Country:US
Practice Address - Phone:330-374-1199
Practice Address - Fax:330-374-0151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-09
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH101YM0800XMedicaid
OH101YM0800XOtherALL PRIVATE INSURANCES
OH101YM0800XMedicare PIN
OH101YM0800XMedicaid