Basic Information
| Provider Information | |||||||||
| NPI: | 1629274824 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAMSEY | ||||||||
| FirstName: | MILDRED | ||||||||
| MiddleName: | CHRISTING | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RAMSEY | ||||||||
| OtherFirstName: | M | ||||||||
| OtherMiddleName: | CHRISTINE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PC | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 555 LAKESHORE DR E | ||||||||
| Address2: | |||||||||
| City: | HEBRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430259711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404050633 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 581 HEBRON RD | ||||||||
| Address2: | |||||||||
| City: | HEATH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430561402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405224673 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | C05000131 | OH | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | LIC | 01 | OH | C05000131 | OTHER |