Provider Demographics
NPI:1063055382
Name:ROAD LESS TRAVELED BEHAVIORAL
Entity type:Organization
Organization Name:ROAD LESS TRAVELED BEHAVIORAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-257-3207
Mailing Address - Street 1:2200 VICTORY PKWY STE 602
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-2837
Mailing Address - Country:US
Mailing Address - Phone:513-614-0407
Mailing Address - Fax:
Practice Address - Street 1:2200 VICTORY PKWY STE 602
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-2837
Practice Address - Country:US
Practice Address - Phone:513-614-0407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty