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Organization
SCIOTO FAMILY AND BEHAVIORAL MEDICINE
Active
Organization
SCIOTO FAMILY AND BEHAVIORAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN HAASTRUP (OWNER)
(270) 871-7379
Entity
Organization
Contact information
Practice address
4502 GALLIA ST, PORTSMOUTH, OH 45662-5541
(740) 529-7020
(740) 529-7085
Mailing address
5611 GALLIA ST, PORTSMOUTH, OH 45662-5520
(740) 529-0083
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0190824
—
OH
05
—
0332290
—
OH
05
—
0359670
—
OH
Enumeration date
07/02/2019
Last updated
09/20/2021
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