Healthcare Provider Details

I. General information

NPI: 1053050013
Provider Name (Legal Business Name): MADISON MARIE WILMOTH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2022
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 BETHEL RD STE 302
COLUMBUS OH
43220-2775
US

IV. Provider business mailing address

3651 BRINELL ST E APT 234
COLUMBUS OH
43214-3793
US

V. Phone/Fax

Practice location:
  • Phone: 614-406-0299
  • Fax:
Mailing address:
  • Phone: 937-570-7552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2608058
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: