Healthcare Provider Details

I. General information

NPI: 1720163900
Provider Name (Legal Business Name): COLUMBUS CENTER FOR BEHAVIOR AND LEARNING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6495 EAST BROAD STREET SUITE C
COLUMBUS OH
43213
US

IV. Provider business mailing address

6495 EAST BROAD STREET SUITE C
COLUMBUS OH
43213
US

V. Phone/Fax

Practice location:
  • Phone: 614-322-9760
  • Fax: 614-322-9762
Mailing address:
  • Phone: 614-322-9760
  • Fax: 614-322-9762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN169328 NP01025
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number959
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5519
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35029221
License Number StateOH

VIII. Authorized Official

Name: MR. ALEX R DUBIN
Title or Position: DIRECTOR OWNER
Credential: MD
Phone: 614-322-9760