Healthcare Provider Details

I. General information

NPI: 1194773317
Provider Name (Legal Business Name): OSU PSYCHIATRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 UPHAM DR SUITE 140
COLUMBUS OH
43210-1250
US

IV. Provider business mailing address

1670 UPHAM DR SUITE 140
COLUMBUS OH
43210-1250
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-9600
  • Fax: 614-293-4200
Mailing address:
  • Phone: 614-293-9600
  • Fax: 614-293-4200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: AMANDA LUCAS
Title or Position: EXECUTIVE DIRECTOR OSU & HARDING
Credential:
Phone: 614-293-8283