Healthcare Provider Details

I. General information

NPI: 1992662001
Provider Name (Legal Business Name): OLIVIA SHAGLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 NORTHWOODS BLVD
COLUMBUS OH
43235-4719
US

IV. Provider business mailing address

7804 SUGAR CREEK RD APT 101
WORTHINGTON OH
43085-5935
US

V. Phone/Fax

Practice location:
  • Phone: 614-805-7430
  • Fax:
Mailing address:
  • Phone: 330-941-9345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2305473
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: