# FAIRBORN MENTAL HEALTH LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Fairborn Mental Health
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972150423
- **Authorized official:** SHEILA RAE DUNN (CEO)
- **Authorized official phone:** (937) 318-8103

## Contact information

- **Practice address:** 323 N BROAD ST, FAIRBORN, OH 45324-4934
- **Practice address phone:** (937) 318-8013
- **Practice address fax:** (937) 867-5268
- **Mailing address:** 323 N BROAD ST, FAIRBORN, OH 45324-4934
- **Mailing address phone:** (937) 318-8013
- **Mailing address fax:** (937) 867-5268

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0401X | Addiction Medicine (Family Medicine) Physician | — | NULL | — |
| 207QA0401X | Addiction Medicine (Family Medicine) Physician | — | — | — |
| 2084A0401X | Addiction Medicine (Psychiatry & Neurology) Physician | — | NULL | Yes |
| 2084A0401X | Addiction Medicine (Psychiatry & Neurology) Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/20/2019
- **Last updated:** 08/20/2019