Provider Demographics
NPI:1407922412
Name:NORTHWEST MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:NORTHWEST MENTAL HEALTH SERVICES
Other - Org Name:NORTHWEST COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:KING
Authorized Official - Last Name:STUMPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-457-7876
Mailing Address - Street 1:1560 FISHINGER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2108
Mailing Address - Country:US
Mailing Address - Phone:614-457-7876
Mailing Address - Fax:614-457-7896
Practice Address - Street 1:1560 FISHINGER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2108
Practice Address - Country:US
Practice Address - Phone:614-457-7876
Practice Address - Fax:614-457-7896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1195Medicaid
4488316OtherAETNA
000000152157OtherANTHEM
9241441Medicare ID - Type Unspecified
OH1195Medicaid