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General NPI Number Information
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NPI Number | 1881059061
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Entity Type | Organization
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Legal Business Name | FORUM OHIO, LLC
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Dates
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Enumeration Date | 12/15/2015
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Last Update Date | 12/15/2015
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Provider Practice Location Address
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Address Line | 20 S 3RD ST SUITE 210
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City | COLUMBUS
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State | OH
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Zip | 43215-4206
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Country | US
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Telephone | 614-309-9727
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Fax | 614-895-6801
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Provider Business Mailing Address
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Address Line | 7440 ROLLING RIDGE WAY
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City | WESTERVILLE
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State | OH
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Zip | 43082-8933
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Country | US
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Telephone | 614-309-9727
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Fax | 614-895-6801
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. BOB STINSON
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Credential | PSYD JD LICDC-S ABPP
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Telephone | 614-309-9727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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