Healthcare Provider Details

I. General information

NPI: 1770665432
Provider Name (Legal Business Name): OHIO DEPARTMENT OF MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 W BROAD ST
COLUMBUS OH
43223-1297
US

IV. Provider business mailing address

2200 W BROAD ST
COLUMBUS OH
43223-1297
US

V. Phone/Fax

Practice location:
  • Phone: 614-752-0333
  • Fax: 614-752-0385
Mailing address:
  • Phone: 614-752-0333
  • Fax: 614-752-0385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number2459
License Number StateOH

VIII. Authorized Official

Name: DR. DANIEL J. POWELL
Title or Position: CLINCIAL PSYCHOLOGIST
Credential: PH.D.
Phone: 614-752-0333