Healthcare Provider Details

I. General information

NPI: 1548024367
Provider Name (Legal Business Name): LIFE SUPPORT BEHAVIORAL HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 BRYDEN RD STE 120
COLUMBUS OH
43215-4839
US

IV. Provider business mailing address

2321 TAYLOR PARK DR # 1024
REYNOLDSBURG OH
43068-8052
US

V. Phone/Fax

Practice location:
  • Phone: 614-705-0347
  • Fax:
Mailing address:
  • Phone: 614-906-9095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: APPECHHA NEUPANE
Title or Position: OWNER
Credential:
Phone: 614-906-9095