| Supertherapy | |
|
59 S Lake St Madison OH 44057-3245 | |
| (234) 212-8254 | |
| Not Available |
| Full Name | Supertherapy |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 59 S Lake St, Madison, Ohio |
| Authorized Official Name and Position | Michael Boyce (CLINICAL COUNSELOR) |
| Authorized Official Contact | 2342128254 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Supertherapy 59 S Lake St Madison OH 44057-3245 Ph: (234) 212-8254 | Supertherapy 59 S Lake St Madison OH 44057-3245 Ph: (234) 212-8254 |
| NPI Number | 1104664341 |
|---|---|
| Provider Enumeration Date | 07/19/2024 |
| Last Update Date | 07/19/2024 |
| Certification Date | 07/19/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104664341 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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