MEDICARE: CAPITAL BEHAVIORAL HEALTH

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	101YP2500X	Professional Counselor	E.1700277	OH

General Provider Information

NPI Number	:	1700305430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPITAL BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	901 ROBINWOOD AVE STE B
Second Line	:
City	:	WHITEHALL
State	:	OH
Zip	:	43213-1781
Country	:	US
Telephone Number	:	614-425-2909
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 ROBINWOOD AVE STE B
Second Line	:
City	:	WHITEHALL
State	:	OH
Zip	:	43213-1781
Country	:	US
Telephone Number	:	614-425-2909
Fax Number	:

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	RAYSHAWN L WILSON
Credential	:	LPCC
Telephone Number	:	614-425-2909

Provider Enumeration Date	:	09/13/2017
Last Update Date	:	07/21/2022

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Directions to “CAPITAL BEHAVIORAL HEALTH ” Practice Location

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