Healthcare Provider Details

I. General information

NPI: 1043946163
Provider Name (Legal Business Name): CFF MEDICAL & BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1569 BENT MAPLE DR
BLACKLICK OH
43004-8197
US

IV. Provider business mailing address

PO BOX 313
BLACKLICK OH
43004-0313
US

V. Phone/Fax

Practice location:
  • Phone: 614-446-6016
  • Fax:
Mailing address:
  • Phone: 614-446-6016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ENESTINE AZENKENG TASONG
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 614-446-6016