Healthcare Provider Details

I. General information

NPI: 1841412897
Provider Name (Legal Business Name): ALBERT W. SCOVERN, PH.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S 5TH ST
COLUMBUS OH
43206-1202
US

IV. Provider business mailing address

520 S 5TH ST
COLUMBUS OH
43206-1202
US

V. Phone/Fax

Practice location:
  • Phone: 614-562-4465
  • Fax:
Mailing address:
  • Phone: 614-562-4465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number3499
License Number StateOH

VIII. Authorized Official

Name: DR. ALBERT W. SCOVERN
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 614-562-4465