Healthcare Provider Details

I. General information

NPI: 1891308870
Provider Name (Legal Business Name): YVONNE JUDGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 CORPORATE EXCHANGE DR STE 100
COLUMBUS OH
43231-1660
US

IV. Provider business mailing address

6750 SAWYERS CREEK RD
WESTERVILLE OH
43081-7676
US

V. Phone/Fax

Practice location:
  • Phone: 614-245-5119
  • Fax:
Mailing address:
  • Phone: 614-245-5119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: YVONNE JUDGE
Title or Position: OWNER
Credential: MFT
Phone: 937-516-3607