MEDICARE: RYZING STARR YOUTH INITIATIVE, 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	:	1528918992
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RYZING STARR YOUTH INITIATIVE, LLC

Provider Business Mailing Address
First Line	:	1802 QUARRY RIDGE DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-1625
Country	:	US
Telephone Number	:	614-581-9323
Fax Number	:

Provider Business Practice Location Address
First Line	:	1802 QUARRY RIDGE DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-1625
Country	:	US
Telephone Number	:	614-581-9323
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MISS ATHA LEEANN SANDERS
Credential	:
Telephone Number	:	614-383-8095

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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