Provider Demographics
NPI:1932253465
Name:THE PHOBIA CLINIC INC
Entity Type:Organization
Organization Name:THE PHOBIA CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLLARES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-435-0998
Mailing Address - Street 1:2179 MIAMISBURG CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3814
Mailing Address - Country:US
Mailing Address - Phone:937-435-0998
Mailing Address - Fax:937-435-7322
Practice Address - Street 1:2179 MIAMISBURG CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-3814
Practice Address - Country:US
Practice Address - Phone:937-435-0998
Practice Address - Fax:937-435-7322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350469222084P0800X
OH57382084P0800X
OH62342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty