MEDICARE: MAIA DYLAN KELNER

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	106H00000X	Marriage & Family Therapist	M.2600483-TRNE	OH

General Provider Information

NPI Number	:	1821936618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAIA DYLAN KELNER

Provider Business Mailing Address
First Line	:	127 E KANAWHA AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-1258
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4937 W BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43228-1646
Country	:	US
Telephone Number	:	614-259-7656
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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Directions to “ MAIA DYLAN KELNER ” Practice Location

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