Healthcare Provider Details

I. General information

NPI: 1801190137
Provider Name (Legal Business Name): AXIS BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2010
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

647 HILL RD N UNIT B
PICKERINGTON OH
43147-9168
US

IV. Provider business mailing address

647 HILL RD N UNIT B
PICKERINGTON OH
43147-9168
US

V. Phone/Fax

Practice location:
  • Phone: 614-833-6900
  • Fax: 614-833-6903
Mailing address:
  • Phone: 614-833-6900
  • Fax: 614-833-6903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberE0001639
License Number StateOH

VIII. Authorized Official

Name: MR. WILLIAM R HARGETT
Title or Position: OWNER
Credential: LPCC
Phone: 614-833-6900