=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679295588
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SONDER PSYCHOTHERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2022
-----------------------------------------------------
Last Update Date | 04/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3246 W HENDERSON RD
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-254-6604
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3246 W HENDERSON RD
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-254-6604
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, CLINICIAL SOCIAL WORKER
-----------------------------------------------------
Name | SARAH O'DONNELL
-----------------------------------------------------
Credential | LISW, PMH-C
-----------------------------------------------------
Telephone | 614-254-6604
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------