Healthcare Provider Details

I. General information

NPI: 1780493254
Provider Name (Legal Business Name): CRISSY BONTRAGER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5990 WILCOX PL STE F
DUBLIN OH
43016-9266
US

IV. Provider business mailing address

7895 SARAHURST DR
DUBLIN OH
43016-9071
US

V. Phone/Fax

Practice location:
  • Phone: 614-662-4965
  • Fax: 614-505-2027
Mailing address:
  • Phone: 614-662-4965
  • Fax: 614-505-2720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CRISSY BONTRAGER
Title or Position: OWNER
Credential: LPCC-S
Phone: 614-662-4965