Healthcare Provider Details

I. General information

NPI: 1124912340
Provider Name (Legal Business Name): ALI AHMED AL KHALAF LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6435 E BROAD ST
COLUMBUS OH
43213-1507
US

IV. Provider business mailing address

60 E 8TH AVE APT 253
COLUMBUS OH
43201-3856
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-2000
  • Fax:
Mailing address:
  • Phone: 614-607-4077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2506995
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: