Healthcare Provider Details

I. General information

NPI: 1558939603
Provider Name (Legal Business Name): JESSICA PATTERSON LPCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 W BROAD ST STE 220
COLUMBUS OH
43222-1471
US

IV. Provider business mailing address

775 W BROAD ST STE 220
COLUMBUS OH
43222-1471
US

V. Phone/Fax

Practice location:
  • Phone: 614-674-6076
  • Fax:
Mailing address:
  • Phone: 614-674-6076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2403978-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: