Provider Demographics
NPI:1457954554
Name:OHIO THERAPY CENTER AND PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:OHIO THERAPY CENTER AND PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEARISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAINES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:330-540-3440
Mailing Address - Street 1:860 BOARDMAN CANFIELD RD STE 203
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4235
Mailing Address - Country:US
Mailing Address - Phone:330-779-1333
Mailing Address - Fax:
Practice Address - Street 1:860 BOARDMAN CANFIELD RD STE 203
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-4235
Practice Address - Country:US
Practice Address - Phone:330-779-1333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-19
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty