Healthcare Provider Details

I. General information

NPI: 1881059061
Provider Name (Legal Business Name): FORUM OHIO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2015
Last Update Date: 12/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 S 3RD ST SUITE 210
COLUMBUS OH
43215-4206
US

IV. Provider business mailing address

7440 ROLLING RIDGE WAY
WESTERVILLE OH
43082-8933
US

V. Phone/Fax

Practice location:
  • Phone: 614-309-9727
  • Fax: 614-895-6801
Mailing address:
  • Phone: 614-309-9727
  • Fax: 614-895-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BOB STINSON
Title or Position: CO-OWNER
Credential: PSYD JD LICDC-S ABPP
Phone: 614-309-9727