Healthcare Provider Details

I. General information

NPI: 1053251397
Provider Name (Legal Business Name): EXCELU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 GRANDVIEW AVE
COLUMBUS OH
43215-1123
US

IV. Provider business mailing address

833 GRANDVIEW AVE
COLUMBUS OH
43215-1123
US

V. Phone/Fax

Practice location:
  • Phone: 937-308-3755
  • Fax:
Mailing address:
  • Phone: 937-308-3755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health 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: AMANDA GABBERT
Title or Position: OPERATIONS DIRECTOR
Credential:
Phone: 937-450-5268