=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285300574
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BARRIE BEHAVIORAL HEALTH AND WELLNESS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2021
-----------------------------------------------------
Last Update Date | 03/25/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1425 E DUBLIN GRANVILLE RD
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43229-3325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-218-2766
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 E CAMPUS VIEW BLVD STE 250
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43235-4682
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-446-1370
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING SPECIALIST
-----------------------------------------------------
Name | MR. MALIK SHEHROZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-403-0544
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------