Healthcare Provider Details

I. General information

NPI: 1053715854
Provider Name (Legal Business Name): JAY FOURNIER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 UPHAM DR FL 3
COLUMBUS OH
43210-1250
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-9600
  • Fax: 614-366-1215
Mailing address:
  • Phone: 614-293-9600
  • Fax: 614-366-1215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP.08378
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS017376
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: