Basic Information
Provider Information
NPI: 1295149763
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCDOWELL
FirstName: KAZI
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 975 KINGSVIEW DR
Address2: SUITE 400
City: LEBANON
State: OH
PostalCode: 450369562
CountryCode: US
TelephoneNumber: 5132287854
FaxNumber: 5132287848
Practice Location
Address1: 50 GREENWOOD LN
Address2:  
City: SPRINGBORO
State: OH
PostalCode: 450663033
CountryCode: US
TelephoneNumber: 9377461154
FaxNumber: 5137468523
Other Information
ProviderEnumerationDate: 06/12/2014
LastUpdateDate: 06/12/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XC-1200683OHY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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