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Organization
MOHICAN YOUTH ACADEMY
Active
Organization
MOHICAN YOUTH ACADEMY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WENDY BRUNO (BILLING CREDENTIALING)
(614) 556-4616
Entity
Organization
Contact information
Practice address
1012 ODNR MOHICAN 51, PERRYSVILLE, OH 44864-9407
(419) 994-0300
Mailing address
1012 ODNR MOHICAN 51, PERRYSVILLE, OH 44864-9407
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-7531
OHIOMHAS
OH
Enumeration date
05/12/2015
Last updated
05/12/2015
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