MEDICARE: DR. JAMES A FIDELIBUS PH.D.

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	79302	OH
2	103TC1900X	Counseling Psychologist	4190	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4190	OTHER	OH	PSYCHOLOGY LICENSE

General Provider Information

NPI Number	:	1740338144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES A FIDELIBUS PH.D.

Provider Business Mailing Address
First Line	:	1115 BETHEL RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-2690
Country	:	US
Telephone Number	:	614-538-0353
Fax Number	:	614-586-1879

Provider Business Practice Location Address
First Line	:	1115 BETHEL RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-2690
Country	:	US
Telephone Number	:	614-538-0353
Fax Number	:	614-586-1879

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	09/11/2025

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