Organization
MOUNDBUILDERS GUIDANCE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAURA L EDELBLUTE (CHIEF OPERATING OFFICER)
(740) 522-8477
Entity
Organization
Contact information
Practice address
1445 W MAIN ST, NEWARK, OH 43055-1989
(740) 522-8477
(740) 522-2941
Mailing address
65 MESSIMER DR, NEWARK, OH 43055-1874
(740) 522-8477
(740) 522-2941
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0200008
—
OH
Enumeration date
04/06/2009
Last updated
04/06/2009
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