MEDICARE: GENERATIONS PSYCHOLOGICAL AND CONSULTATION SERVICES 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1548807704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENERATIONS PSYCHOLOGICAL AND CONSULTATION SERVICES LLC

Provider Business Mailing Address
First Line	:	855 EBNER ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43206-2361
Country	:	US
Telephone Number	:	309-531-3504
Fax Number	:

Provider Business Practice Location Address
First Line	:	1520 OLD HENDERSON RD STE E
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-3639
Country	:	US
Telephone Number	:	309-531-3504
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST
Name	:	DR. TERESA YOUNG
Credential	:	PHD
Telephone Number	:	614-328-9528

Provider Enumeration Date	:	12/06/2019
Last Update Date	:	12/06/2019

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