Healthcare Provider Details

I. General information

NPI: 1285321570
Provider Name (Legal Business Name): ELISABETH A PRENTIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 ARLINGTON CENTRE BLVD STE 2277B
COLUMBUS OH
43220-3084
US

IV. Provider business mailing address

5000 ARLINGTON CENTRE BLVD STE 2277B
COLUMBUS OH
43220-3084
US

V. Phone/Fax

Practice location:
  • Phone: 614-665-0665
  • Fax:
Mailing address:
  • Phone: 614-665-0665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.2608125
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: