Healthcare Provider Details

I. General information

NPI: 1891320511
Provider Name (Legal Business Name): OHIO MARRIAGE AND FAMILY THERAPY, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2020
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1491 POLARIS PKWY STE 216
COLUMBUS OH
43240-2041
US

IV. Provider business mailing address

1491 POLARIS PKWY STE 216
COLUMBUS OH
43240-2041
US

V. Phone/Fax

Practice location:
  • Phone: 614-568-1258
  • Fax:
Mailing address:
  • Phone: 614-568-1258
  • 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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. DOMONIQUE RICE
Title or Position: OWNER
Credential: IMFT-S
Phone: 614-568-1258