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General NPI Number Information
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NPI Number | 1184431280
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Entity Type | Organization
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Legal Business Name | FIRST LIGHT WELLNESS CENTER
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Dates
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Enumeration Date | 12/12/2024
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 6463 PROPRIETORS RD STE 201
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City | WORTHINGTON
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State | OH
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Zip | 43085-3263
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Country | US
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Telephone | 513-629-0040
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Fax |
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Provider Business Mailing Address
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Address Line | 6463 PROPRIETORS RD STE 201
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City | WORTHINGTON
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State | OH
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Zip | 43085-3263
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Country | US
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Telephone | 513-629-0040
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Fax |
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | PAUL KYEI
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Credential |
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Telephone | 513-629-0040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 364SP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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