The Marysville Union Clubhouse

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

THE MARYSVILLE UNION CLUBHOUSE

Practice address

16645 Square Dr
Marysville, OH 43040-3510

Phone

(513) 703-5078

NPI assigned

Aug 7, 2023

Organization subpart

No

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

Authorized official

Name

Haley Bowra, LISW-SNPI 1851980114

Title

Clinical Director

Phone

(513) 703-5078

Specialties & licenses 1

Addresses

Other names 1

• The Marysville Union Doing business as

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Tax ID family

The Marysville Union2 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.

• The Marysville Union

  • Community/Behavioral Health Agency
  • Marysville, OH
  • NPI 1336916139
  NPD tax ID

Practitioners 4

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

• Bryan David Borland, DO

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • Columbus, OH
  • NPI 1457643637
  Medicare reassignment NPD
• Haley Bowra, LSW

  • Clinical Social Worker
  • Fairfield, OH
  • NPI 1851980114
  NPD (past) Authorized official
• Joseph William Johnson

  • Addiction (Substance Use Disorder) Counselor
  • Marion, OH
  • NPI 1477364396
  NPD
• Laney Willey

  • Case Manager/Care Coordinator
  • Columbus, OH
  • NPI 1699400697
  NPD

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

{
    "created_epoch": "1691366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738195200000",
    "number": "1992487136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16645 SQUARE DR",
            "city": "MARYSVILLE",
            "state": "OH",
            "postal_code": "430403510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16645 SQUARE DR",
            "city": "MARYSVILLE",
            "state": "OH",
            "postal_code": "430403510",
            "telephone_number": "513-703-5078"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "125 Executive Dr",
            "address_purpose": "LOCATION",
            "city": "Marion",
            "state": "OH",
            "postal_code": "433026285",
            "country_code": "US",
            "telephone_number": "937-250-1433",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "THE MARYSVILLE UNION CLUBHOUSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-07",
        "last_updated": "2025-01-30",
        "certification_date": "2025-01-30",
        "status": "A",
        "authorized_official_last_name": "BOWRA",
        "authorized_official_first_name": "HALEY",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "513-703-5078",
        "authorized_official_credential": "LISW-S"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Marysville Union",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Keith A Tebbe, MS, ATC
• Monica Vora Tejani, D.O.
• The Kroger Co
• The Main Quest Counseling
• The Marysville Union
• The Story of Autism
• Matthew Steven Thompson, OD
• Megan Thompson, LSW
• Sudha Swamy Thompson, MD
• Teresa Thompson, PTA

• Substance Use Disorder Rehabilitation Clinic/Center in Marysville, OH
• Providers in Marysville, OH by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2025; 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.