Healthcare Provider Details

I. General information

NPI: 1366466955
Provider Name (Legal Business Name): COLUMBUS AREA INTEGRATED HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 10/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 E BROAD ST
COLUMBUS OH
43205-1550
US

IV. Provider business mailing address

1515 E BROAD ST
COLUMBUS OH
43205-1550
US

V. Phone/Fax

Practice location:
  • Phone: 614-251-0711
  • Fax: 614-252-9250
Mailing address:
  • Phone: 614-251-0711
  • Fax: 614-252-9250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number0275
License Number StateOH

VIII. Authorized Official

Name: SHIRLEY D SIMPSON
Title or Position: BILLING MANAGER
Credential:
Phone: 614-251-7723