MEDICARE: MAHOGANY RESTORATIVE COUNSELING, 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1255059051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAHOGANY RESTORATIVE COUNSELING, LLC

Provider Business Mailing Address
First Line	:	470 W BROAD ST # 1155
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43215-2759
Country	:	US
Telephone Number	:	614-992-3525
Fax Number	:

Provider Business Practice Location Address
First Line	:	2303 MEADOW VILLAGE DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-4913
Country	:	US
Telephone Number	:	980-200-5978
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATIOR
Name	:	KEYASIA DOWNS
Credential	:	MSW, LISW
Telephone Number	:	980-200-5978

Provider Enumeration Date	:	08/17/2022
Last Update Date	:	08/17/2022

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