Organization
MOUNDBUILDERS GUIDANCE CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PATRICK C EVANS (CEO)
(740) 788-3400
Entity
Organization
Contact information
Practice address
8402 BLACKJACK ROAD EXT, MOUNT VERNON, OH 43050-9193
(740) 397-0442
(740) 392-1814
Mailing address
8402 BLACKJACK ROAD EXT, MOUNT VERNON, OH 43050-9193
(740) 397-0442
(740) 392-1814
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0200008
MEDICARE CROSSOVER
OH
01
—
2485734
RISPERDAL
OH
05
—
MC-26
—
OH
Enumeration date
05/04/2006
Last updated
05/09/2008
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