Healthcare Provider Details

I. General information

NPI: 1407922412
Provider Name (Legal Business Name): NORTHWEST MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 FISHINGER RD
COLUMBUS OH
43221-2108
US

IV. Provider business mailing address

1560 FISHINGER RD
COLUMBUS OH
43221-2108
US

V. Phone/Fax

Practice location:
  • Phone: 614-457-7876
  • Fax: 614-457-7896
Mailing address:
  • Phone: 614-457-7876
  • Fax: 614-457-7896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AUSTIN KING STUMPP
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 614-457-7876