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NPI Code Detail

MEDICARE: KAVANAH PSYCHIATRY LLC

MEDICARE: KAVANAH PSYCHIATRY 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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1992667844
Entity Type Code : Organization
Provider Name (Legal Business Name) : KAVANAH PSYCHIATRY LLC
Provider Business Mailing Address
First Line : 179 CREEKSIDE GREEN DR
Second Line :
City : COLUMBUS
State : OH
Zip : 43230-2880
Country : US
Telephone Number : 624-877-6158
Fax Number : 614-392-9005
Provider Business Practice Location Address
First Line : 179 CREEKSIDE GREEN DR
Second Line :
City : COLUMBUS
State : OH
Zip : 43230-2880
Country : US
Telephone Number : 624-877-6158
Fax Number : 614-392-9005
Authorized Official
Title or Position : FOUNDER/PMHNP
Name : OLIVIA DAVIS
Credential : PMHNP-BC
Telephone Number : 614-977-6158
Provider Enumeration Date : 12/01/2025
Last Update Date : 12/01/2025

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