MEDICARE: MR. MICHAEL ANTHONY FEENEY I

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	APP-000773448	OH
2	175T00000X	Peer Specialist	APS003896	OH

General Provider Information

NPI Number	:	1497523310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL ANTHONY FEENEY I

Provider Business Mailing Address
First Line	:	1414 OAKLAND PARK AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-3507
Country	:	US
Telephone Number	:	833-749-4325
Fax Number	:

Provider Business Practice Location Address
First Line	:	1414 OAKLAND PARK AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-3507
Country	:	US
Telephone Number	:	833-749-4325
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2023
Last Update Date	:	12/20/2023

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