Healthcare Provider Details

I. General information

NPI: 1740146489
Provider Name (Legal Business Name): DR. ALFONSO LOUIS FLOYD JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2025
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2857 W BROAD ST
COLUMBUS OH
43204-2643
US

IV. Provider business mailing address

2857 W BROAD ST
COLUMBUS OH
43204-2643
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-4700
  • Fax: 614-722-4718
Mailing address:
  • Phone: 614-722-4700
  • Fax: 614-722-4718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: