Healthcare Provider Details

I. General information

NPI: 1669444329
Provider Name (Legal Business Name): EMILY PROGRAM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 RAVINES EDGE CT
COLUMBUS OH
43235-5423
US

IV. Provider business mailing address

1295 BANDANA BLVD N STE 210
SAINT PAUL MN
55108-5115
US

V. Phone/Fax

Practice location:
  • Phone: 866-364-5977
  • Fax: 614-896-8223
Mailing address:
  • Phone: 651-645-5323
  • Fax: 651-379-6105

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

VIII. Authorized Official

Name: KATHERINE NORRIS
Title or Position: GENERAL COUNSEL
Credential: JD
Phone: 888-364-5977