Provider Demographics
NPI:1891761250
Name:COMMUNITY MENTAL HEALTH CENTER OF CLINTON COUNTY
Entity Type:Organization
Organization Name:COMMUNITY MENTAL HEALTH CENTER OF CLINTON COUNTY
Other - Org Name:MHRCCC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMONIGLE
Authorized Official - Suffix:
Authorized Official - Credentials:PCC
Authorized Official - Phone:513-228-7800
Mailing Address - Street 1:975 FUJITEC BLDG A
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036
Mailing Address - Country:US
Mailing Address - Phone:513-228-7800
Mailing Address - Fax:513-228-7848
Practice Address - Street 1:975 FUJITEC BLDG A
Practice Address - Street 2:SUITE 1
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036
Practice Address - Country:US
Practice Address - Phone:513-228-7800
Practice Address - Fax:513-228-7848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH266261QM0801X
OH83613261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2473998Medicaid
OH2473998Medicaid
1048Medicare UPIN
ME9288861Medicare ID - Type Unspecified