Healthcare Provider Details

I. General information

NPI: 1215597299
Provider Name (Legal Business Name): BRIANNA MEKELBURG MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 01/14/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 HUNTINGTON PARK DR
COLUMBUS OH
43235-5617
US

IV. Provider business mailing address

880 THOMAS AVE
COLUMBUS OH
43223-1503
US

V. Phone/Fax

Practice location:
  • Phone: 614-505-0377
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: