Southwestern Ohio Behavioral Health,LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

4664 Issued in OH

Legal business name

SOUTHWESTERN OHIO BEHAVIORAL HEALTH,LLC

Practice address

35 Irongate Park Dr
Centerville, OH 45459-4616

Phone

(937) 435-8864

Fax

(937) 435-8264

NPI assigned

Oct 11, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Kimberly Shaffer Tate, PSY.DNPI 1154418903

Title

Owner-Clinical Psychologist

Phone

(937) 435-8864

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Locations

Practitioners 1

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

• Kimberly Shaffer Tate, PSY.D.

  • Clinical Psychologist
  • Centerville, OH
  • NPI 1154418903
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309305600000",
    "number": "1376631713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 41158",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454410158",
            "telephone_number": "937-435-8864",
            "fax_number": "937-435-8264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 IRONGATE PARK DR",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454594616",
            "telephone_number": "937-435-8864",
            "fax_number": "937-435-8264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWESTERN OHIO BEHAVIORAL HEALTH,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2011-06-29",
        "status": "A",
        "authorized_official_last_name": "TATE",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "SHAFFER",
        "authorized_official_title_or_position": "OWNER-CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "937-435-8864",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "OH",
            "license": "4664",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jalpa Shivam Soni, MD
• Emily P Sorensen, NP-C
• Victoria Nicole Sorice
• South Suburban Mental Health Group
• Southwest Cardiology Inc
• Kathy Sowder, LPCC, CCDC, III E
• Darcy Spires
• Kerianne Springer, M.D.
• Mary Carleen Sprow, PHARMD
• St Leonard

• Clinical Psychologist in Centerville, OH
• Providers in Centerville, OH by specialty
• Clinical Psychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.