Healthcare Provider Details

I. General information

NPI: 1982936951
Provider Name (Legal Business Name): GENERATING EMPOWERED MINDS SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1723 RUSHING WAY
COLUMBUS OH
43235-4331
US

IV. Provider business mailing address

1723 RUSHING WAY
COLUMBUS OH
43235-4331
US

V. Phone/Fax

Practice location:
  • Phone: 614-525-9638
  • Fax: 614-573-7186
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberI. 0010240 SUPV
License Number StateOH

VIII. Authorized Official

Name: MRS. LIAT JOHNSON
Title or Position: SENIOR ADMINISTRATOR
Credential: LISW-S
Phone: 614-525-9638