Healthcare Provider Details

I. General information

NPI: 1598248015
Provider Name (Legal Business Name): ROBERT LLOYD YURISKO LISW-S, LICDC-CS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 S HIGH ST
COLUMBUS OH
43206-3413
US

IV. Provider business mailing address

1470 KING AVE APT 7
COLUMBUS OH
43212-2127
US

V. Phone/Fax

Practice location:
  • Phone: 614-448-0123
  • Fax:
Mailing address:
  • Phone: 614-448-0123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC-CS.162210
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2405114-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: