Basic Information
| Provider Information | |||||||||
| NPI: | 1467732214 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNISON BEHAVIORAL HEALTH GROUP, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1425 STARR AVE | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436052456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196930631 | ||||||||
| FaxNumber: | 4199367606 | ||||||||
| Practice Location | |||||||||
| Address1: | 1425 STARR AVE | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436052456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196930631 | ||||||||
| FaxNumber: | 4199367606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2011 | ||||||||
| LastUpdateDate: | 10/31/2013 | ||||||||
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| AuthorizedOfficialLastName: | WEISS | ||||||||
| AuthorizedOfficialFirstName: | COURTNEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 4196930631 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LISW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 51720 | 01 | OH | PARAMOUNT HEALTH CARE | OTHER |