Healthcare Provider Details

I. General information

NPI: 1386987386
Provider Name (Legal Business Name): UMCH FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 E BROAD ST
COLUMBUS OH
43215-4004
US

IV. Provider business mailing address

431 E BROAD ST
COLUMBUS OH
43215-4004
US

V. Phone/Fax

Practice location:
  • Phone: 614-885-5020
  • Fax: 614-885-4058
Mailing address:
  • Phone: 614-885-5020
  • Fax: 614-885-4058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberC.0900670
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SEAN REILLY
Title or Position: EXECUTIVE DIRECTOR
Credential: LISW-S
Phone: 614-885-5020