MEDICARE: COLUMBUS COUNSELING CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1235713975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBUS COUNSELING CENTER, LLC

Provider Business Mailing Address
First Line	:	572 S 250 E
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-4023
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2520 CALIFORNIA ST STE A
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-3677
Country	:	US
Telephone Number	:	812-379-3768
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	ROBIN KNORR
Credential	:	LCSW
Telephone Number	:	812-379-3768

Provider Enumeration Date	:	05/10/2021
Last Update Date	:	05/10/2021

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