| Professional Behavioral Support Llc | |
|
691 E Dublin Granville Rd Columbus OH 43229-3209 | |
| (614) 715-2154 | |
| (614) 705-6577 |
| Full Name | Professional Behavioral Support Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 691 E Dublin Granville Rd, Columbus, Ohio |
| Authorized Official Name and Position | Elieth Kokwesiga Kamala (PSCHIATRIC NURSE PRACTICTITIONER) |
| Authorized Official Contact | 6145741823 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Professional Behavioral Support Llc 691 E Dublin Granville Rd Columbus OH 43229-3209 Ph: (614) 574-1824 | Professional Behavioral Support Llc 691 E Dublin Granville Rd Columbus OH 43229-3209 Ph: (614) 715-2154 |
| NPI Number | 1174201545 |
|---|---|
| Provider Enumeration Date | 07/06/2023 |
| Last Update Date | 12/09/2023 |
| Certification Date | 12/09/2023 |
| Medicare PECOS PAC ID | 9032566815 |
|---|---|
| Medicare Enrollment ID | O20231116000420 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174201545 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Norman Allan Schwartz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255322335 PECOS PAC ID: 4587796644 Enrollment ID: I20100726000153 |
| Provider Name | Elieth K Kamala |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639343007 PECOS PAC ID: 6507211349 Enrollment ID: I20231206002292 |
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