Provider Demographics
NPI: | 1013498971 |
---|---|
Name: | CASS - MIND |
Entity Type: | Organization |
Organization Name: | CASS - MIND |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | VP & DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | BENJAMIN |
Authorized Official - Middle Name: | ALLEN |
Authorized Official - Last Name: | MCDONALD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 330-687-3086 |
Mailing Address - Street 1: | 4467 SAINT GERMAIN BLVD |
Mailing Address - Street 2: | |
Mailing Address - City: | WARRENSVILLE HEIGHTS |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 44128-6202 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 330-687-3086 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 405 MOXAHALA AVE |
Practice Address - Street 2: | |
Practice Address - City: | ZANESVILLE |
Practice Address - State: | OH |
Practice Address - Zip Code: | 43701-4915 |
Practice Address - Country: | US |
Practice Address - Phone: | 330-687-3086 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-08-28 |
Last Update Date: | 2018-08-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Single Specialty | |
No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Single Specialty | |
No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Single Specialty |
No | 103TP0814X | Behavioral Health & Social Service Providers | Psychologist | Psychoanalysis | Group - Single Specialty |
No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | Group - Single Specialty |
No | 221700000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Art Therapist | Group - Single Specialty | |
No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Single Specialty | |
No | 225A00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Music Therapist | Group - Single Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Single Specialty | |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Single Specialty |