Healthcare Provider Details

I. General information

NPI: 1194663047
Provider Name (Legal Business Name): FOUNDATION YOUTH INTERVENTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2177 E LIVINGSTON AVE
COLUMBUS OH
43209-2853
US

IV. Provider business mailing address

128 SHIP ML APT 204
COLUMBUS OH
43207-3792
US

V. Phone/Fax

Practice location:
  • Phone: 614-615-0002
  • Fax:
Mailing address:
  • Phone: 614-615-0002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DEON PADGETT SR.
Title or Position: OWNER
Credential:
Phone: 614-615-0002