Healthcare Provider Details

I. General information

NPI: 1215400924
Provider Name (Legal Business Name): GLOBAL WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 CLEVELAND AVE STE 1964
COLUMBUS OH
43224-3677
US

IV. Provider business mailing address

2525 TILLER LN STE 107
COLUMBUS OH
43231-2267
US

V. Phone/Fax

Practice location:
  • Phone: 614-588-9830
  • Fax: 614-523-3388
Mailing address:
  • Phone: 614-588-9830
  • Fax: 614-523-3388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: YASSIN MATAN
Title or Position: PRESIDENT
Credential:
Phone: 614-588-9830