Healthcare Provider Details

I. General information

NPI: 1962336180
Provider Name (Legal Business Name): THINK MAKE LIVE YOUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 E MAIN ST
COLUMBUS OH
43205-2262
US

IV. Provider business mailing address

1890 E MAIN ST
COLUMBUS OH
43205-2262
US

V. Phone/Fax

Practice location:
  • Phone: 614-549-9336
  • Fax:
Mailing address:
  • Phone: 614-549-9336
  • Fax:

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: MUJADDID MUHAMMAD
Title or Position: DIRECTOR OF PROGRAMS
Credential: LICENSED SOCIAL WORK
Phone: 614-549-9336