Healthcare Provider Details

I. General information

NPI: 1700431657
Provider Name (Legal Business Name): OHIO TMS CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2019
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3099 SULLIVANT AVE
COLUMBUS OH
43204-1895
US

IV. Provider business mailing address

3099 SULLIVANT AVE STE H
COLUMBUS OH
43204-1895
US

V. Phone/Fax

Practice location:
  • Phone: 614-371-2303
  • Fax:
Mailing address:
  • Phone: 614-371-2303
  • Fax: 800-905-9950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ALICJA MATUSIAK
Title or Position: SOLE MEMBER / DIRECTOR
Credential: PMHNP-BC
Phone: 614-371-2303