Healthcare Provider Details

I. General information

NPI: 1083905830
Provider Name (Legal Business Name): PROVIDERS FOR HEALTHY LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8351 N HIGH ST STE 155
COLUMBUS OH
43235-1409
US

IV. Provider business mailing address

8351 N HIGH ST STE 155
COLUMBUS OH
43235-1409
US

V. Phone/Fax

Practice location:
  • Phone: 614-664-3595
  • Fax: 614-664-3595
Mailing address:
  • Phone: 614-664-3595
  • Fax: 614-664-3595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
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: DR. MATTHEW LOWE
Title or Position: PSYCHIATRIST
Credential: D.O.
Phone: 614-664-3595