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General NPI Number Information
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NPI Number | 1245003698
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Entity Type | Organization
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Legal Business Name | REGGIE PINE THERAPY LLC
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Dates
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Enumeration Date | 11/06/2023
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Last Update Date | 07/16/2024
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Provider Practice Location Address
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Address Line | 2939 KENNY RD STE 195
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City | COLUMBUS
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State | OH
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Zip | 43221-2406
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Country | US
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Telephone | 614-957-0164
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Fax |
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Provider Business Mailing Address
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Address Line | 2939 KENNY RD STE 195
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City | COLUMBUS
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State | OH
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Zip | 43221-2406
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Country | US
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Telephone | 614-957-0164
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Fax | 614-417-5455
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Authorized Official
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Title or Position | OWNER
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Name | REGGIE PINE MCCLOSKEY
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Credential | MFT
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Telephone | 614-957-0164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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