Healthcare Provider Details

I. General information

NPI: 1518667732
Provider Name (Legal Business Name): LIFE REFOCUSED, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 11/13/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 GILBERT ST.
COLUMBUS OH
43205-2763
US

IV. Provider business mailing address

6271 MCNAUGHTEN PLACE LN
COLUMBUS OH
43213-6307
US

V. Phone/Fax

Practice location:
  • Phone: 614-407-4198
  • Fax:
Mailing address:
  • Phone: 614-906-3436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: BRIDGET PERRIN
Title or Position: CEO
Credential: LISW-S
Phone: 614-906-3436