Provider Demographics
NPI:1134365745
Name:COMMUNITY BEHAVIORAL HEALTH, INC.
Entity type:Organization
Organization Name:COMMUNITY BEHAVIORAL HEALTH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOELLNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-785-4742
Mailing Address - Street 1:820 S. MARTIN LUTHER KING, JR. BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-3216
Mailing Address - Country:US
Mailing Address - Phone:513-887-8500
Mailing Address - Fax:513-737-8196
Practice Address - Street 1:820 S MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-3216
Practice Address - Country:US
Practice Address - Phone:513-887-8500
Practice Address - Fax:513-737-8196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-02
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-13115000332900000X
OH10993101YA0400X
OH0481101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2846611OtherCROSSOVER
OHCO9345631Medicare UPIN