MEDICARE: AFFIRMATIONS PSYCHOLOGICAL SERVICES, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	305R00000X	Preferred Provider Organization	OH
3	261QM1300X	Multi-Specialty Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265503536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFIRMATIONS PSYCHOLOGICAL SERVICES, LLC

Provider Business Mailing Address
First Line	:	620 E BROAD ST.
Second Line	:	STE. 100 & 301
City	:	COLUMBUS
State	:	OH
Zip	:	43215-4037
Country	:	US
Telephone Number	:	614-445-8277
Fax Number	:	614-445-8283

Provider Business Practice Location Address
First Line	:	620 E BROAD ST.
Second Line	:	STE. 100 & 301
City	:	COLUMBUS
State	:	OH
Zip	:	43215-4037
Country	:	US
Telephone Number	:	614-445-8277
Fax Number	:	614-445-8283

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LESLIE FUCHS
Credential	:
Telephone Number	:	810-358-1643

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	03/24/2025

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