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General NPI Number Information
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NPI Number | 1497576730
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Entity Type | Organization
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Legal Business Name | MASTERMIND MENTAL HEALTH LLC
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Dates
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Enumeration Date | 10/19/2024
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 2109 LANTERN DR
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City | COLUMBUS
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State | OH
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Zip | 43224-5015
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Country | US
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Telephone | 614-632-1572
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Fax |
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Provider Business Mailing Address
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Address Line | 2109 LANTERN DR
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City | COLUMBUS
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State | OH
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Zip | 43224-5015
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Country | US
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Telephone | 614-632-1572
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MOHAMED ABDULLAHI LLC
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Credential | QMHS
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Telephone | 614-632-1572
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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Taxonomy #3
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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Taxonomy #4
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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Taxonomy #5
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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Taxonomy #6
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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Taxonomy #7
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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