UPI (Provider ID): 10062
Change Report (if Any):

Short Name: CLERMONT COUNS

Long Name 1: CLERMONT COUNSELING CENTER
Long Name 2:

Address 1: 43 EAST MAIN STREET
Address 2:

City: AMELIA
Zip Code: 45102
County: CLER

Contact: SCOTT STIVER
Title: MIS
Phone: 5139477000
FAX: 5139477001

Vendor: 10062

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 12/15/2011

File Produced: 19MAY2012