Provider Demographics
NPI:1245917392
Name:CONNECTING HEMISPHERES BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:CONNECTING HEMISPHERES BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART-MODIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-374-8865
Mailing Address - Street 1:PO BOX 9031
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44904-9031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 W 4TH ST STE 114
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44902-1206
Practice Address - Country:US
Practice Address - Phone:614-374-8865
Practice Address - Fax:949-695-2511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty