Survivor Advocacy Outreach Program

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

SURVIVOR ADVOCACY OUTREACH PROGRAM

Practice address

55 W Washington St
Nelsonville, OH 45764-1134

Phone

(740) 591-4266

NPI assigned

Sep 28, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Madison Nmi Trace

Title

Coo

Phone

(740) 274-1727

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Heather Mitchell, LISW-S

  • Clinical Social Worker
  • Nelsonville, OH
  • NPI 1457909582
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1695859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738627200000",
    "number": "1235918145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 W WASHINGTON ST",
            "city": "NELSONVILLE",
            "state": "OH",
            "postal_code": "457641134",
            "telephone_number": "740-591-4266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 W WASHINGTON ST",
            "city": "NELSONVILLE",
            "state": "OH",
            "postal_code": "457641134",
            "telephone_number": "740-591-4266"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "145 Columbus Rd Ste 201",
            "address_purpose": "LOCATION",
            "city": "Athens",
            "state": "OH",
            "postal_code": "457011357",
            "country_code": "US",
            "telephone_number": "740-591-4266",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "31 Public Sq",
            "address_purpose": "LOCATION",
            "city": "Nelsonville",
            "state": "OH",
            "postal_code": "457641132",
            "country_code": "US",
            "telephone_number": "740-591-4266",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SURVIVOR ADVOCACY OUTREACH PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-28",
        "last_updated": "2025-02-04",
        "certification_date": "2025-02-04",
        "status": "A",
        "authorized_official_last_name": "TRACE",
        "authorized_official_first_name": "MADISON",
        "authorized_official_middle_name": "NMI",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "740-274-1727"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Ann Staker-Brown, DO
• Tiffani Staten
• Rachel Stewart, QMHS
• Amy Stocker, QMHS
• Mikayla Jo Stonerock
• Phibawan Syiemlieh, CT
• Hayley Leigh Tausch
• Jay Taylor, QMHS
• Annastasia Tennant
• The Doctors Office Corporation

• Mental Health Clinic/Center (Including Community Mental Health Center) in Nelsonville, OH
• Providers in Nelsonville, OH by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.