=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700650397
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WELLBEING PSYCHIATRIC SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2023
-----------------------------------------------------
Last Update Date | 11/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3636 ASHRIDGE ST
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43219-6205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-432-3708
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3636 ASHRIDGE ST
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43219-6205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-432-3708
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NEEMA MRISHO
-----------------------------------------------------
Credential | CNP
-----------------------------------------------------
Telephone | 614-432-3708
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------