MEDICARE: BLUE LION THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1205782646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE LION THERAPY LLC

Provider Business Mailing Address
First Line	:	766 MOUNT VERNON AVE APT 302
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43203-3606
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	766 MOUNT VERNON AVE APT 302
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43203-3606
Country	:	US
Telephone Number	:	614-439-7128
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	CAROLINE MARTIN
Credential	:	LISW-S
Telephone Number	:	614-439-7128

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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