NPIMap

Organization Active NPI

Fairborn Mental Health LLC

Doing business as Fairborn Mental Health

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • Fairborn, OH
National Provider Identifier
1972150423
Registry record updated Aug 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084A0401X
Legal business name
FAIRBORN MENTAL HEALTH LLC
Doing business as
Fairborn Mental Health
Practice address
323 N Broad St
Fairborn, OH 45324-4934
Phone
(937) 318-8013
Fax
(937) 867-5268
NPI assigned
Aug 20, 2019
Last updated
Aug 20, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2019

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

Authorized official

Name
Sheila Rae DunnNPI 1427428929
Title
Ceo
Phone
(937) 318-8103

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0401X
Addiction Medicine (Psychiatry & Neurology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084A0401X Primary

Addresses

Primary practice location

323 N Broad St
Fairborn, OH 45324-4934

Mailing address

323 N Broad St
Fairborn, OH 45324-4934
Phone (937) 318-8013

Other names 1

  • Fairborn Mental Health Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Fairborn Mental Health2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1566259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566259200000",
    "number": "1972150423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "323 N BROAD ST",
            "city": "FAIRBORN",
            "state": "OH",
            "postal_code": "453244934",
            "telephone_number": "937-318-8013",
            "fax_number": "937-867-5268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "323 N BROAD ST",
            "city": "FAIRBORN",
            "state": "OH",
            "postal_code": "453244934",
            "telephone_number": "937-318-8013",
            "fax_number": "937-867-5268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRBORN MENTAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-20",
        "last_updated": "2019-08-20",
        "status": "A",
        "authorized_official_last_name": "DUNN",
        "authorized_official_first_name": "SHEILA",
        "authorized_official_middle_name": "RAE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "937-318-8103"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084A0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fairborn Mental Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairborn, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2019; 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.