Provider Demographics
NPI:1073044004
Name:SOUTHEAST COMMUNITY MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:SOUTHEAST COMMUNITY MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DANGLER
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:614-444-0800
Mailing Address - Street 1:1455 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-1011
Mailing Address - Country:US
Mailing Address - Phone:614-327-9008
Mailing Address - Fax:
Practice Address - Street 1:1455 S 4TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-1011
Practice Address - Country:US
Practice Address - Phone:614-327-9008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-22
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1440478251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health