Healthcare Provider Details

I. General information

NPI: 1568370377
Provider Name (Legal Business Name): ASSURED MENTAL FITNESS OH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CROWN PARK CT STE B
COLUMBUS OH
43235-2407
US

IV. Provider business mailing address

7936 FRANKFORD AVE
PHILADELPHIA PA
19136-3016
US

V. Phone/Fax

Practice location:
  • Phone: 215-883-8788
  • Fax:
Mailing address:
  • Phone: 215-883-8788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ELBERT CHAN
Title or Position: DIRECTOR
Credential:
Phone: 215-883-8788