| Southwestern Ohio Behavioral Health,llc | |
|
35 Irongate Park Dr Centerville OH 45459-4616 | |
| (937) 435-8864 | |
| (937) 435-8264 |
| Full Name | Southwestern Ohio Behavioral Health,llc |
|---|---|
| Speciality | Psychologist |
| Location | 35 Irongate Park Dr, Centerville, Ohio |
| Authorized Official Name and Position | Kimberly Shaffer Tate (OWNER-CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 9374358864 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southwestern Ohio Behavioral Health,llc Po Box 41158 Dayton OH 45441-0158 Ph: (937) 435-8864 | Southwestern Ohio Behavioral Health,llc 35 Irongate Park Dr Centerville OH 45459-4616 Ph: (937) 435-8864 |
| NPI Number | 1376631713 |
|---|---|
| Provider Enumeration Date | 10/11/2006 |
| Last Update Date | 06/29/2011 |
| Medicare PECOS PAC ID | 1658324579 |
|---|---|
| Medicare Enrollment ID | O20050302000852 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376631713 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 4664 (Ohio) | Primary |
| Provider Name | Kimberly S Tate |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1154418903 PECOS PAC ID: 0648223578 Enrollment ID: I20050304000002 |
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