MEDICARE: 614 HEALTH AND WELLNESS SERVICES

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1578355186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	614 HEALTH AND WELLNESS SERVICES

Provider Business Mailing Address
First Line	:	2960 E DUBLIN GRANVILLE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-4067
Country	:	US
Telephone Number	:	614-974-6772
Fax Number	:

Provider Business Practice Location Address
First Line	:	2960 E DUBLIN GRANVILLE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-4067
Country	:	US
Telephone Number	:	614-974-6772
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KELLEY SPENCE
Credential	:
Telephone Number	:	614-974-6772

Provider Enumeration Date	:	05/20/2025
Last Update Date	:	05/20/2025

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