Healthcare Provider Details

I. General information

NPI: 1154277382
Provider Name (Legal Business Name): MAURICE COLBERT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5340 E MAIN ST STE 107
WHITEHALL OH
43213-2574
US

IV. Provider business mailing address

248 BEXHILL DR
BLACKLICK OH
43004-9069
US

V. Phone/Fax

Practice location:
  • Phone: 614-604-7234
  • Fax: 614-604-7247
Mailing address:
  • Phone: 614-584-4149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: