Provider Demographics
NPI:1902218779
Name:STATE OF OHIO
Entity Type:Organization
Organization Name:STATE OF OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:PRINCESS
Authorized Official - Middle Name:
Authorized Official - Last Name:CRIPE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:740-852-2454
Mailing Address - Street 1:1049 SEACOVE CIR
Mailing Address - Street 2:APT. G
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-9134
Mailing Address - Country:US
Mailing Address - Phone:740-852-2454
Mailing Address - Fax:
Practice Address - Street 1:1580 STATE ROUTE 56 SW
Practice Address - Street 2:LONDON CORRECTIONAL INSTITUTION
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-8623
Practice Address - Country:US
Practice Address - Phone:740-852-2454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6854251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health