Healthcare Provider Details

I. General information

NPI: 1548201262
Provider Name (Legal Business Name): CENTER FOR COGNITIVE BEHAVIORAL THERAPY OF GREATER COLUMBUS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4624 SAWMILL RD
COLUMBUS OH
43220-2247
US

IV. Provider business mailing address

4624 SAWMILL RD
COLUMBUS OH
43220-2247
US

V. Phone/Fax

Practice location:
  • Phone: 614-459-4490
  • Fax: 614-457-3656
Mailing address:
  • Phone: 614-459-4490
  • Fax: 614-457-3656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: LESLIE JOHNSEN
Title or Position: CEO
Credential:
Phone: 810-358-1643