Provider Demographics
NPI:1417683780
Name:PACHANA, ANGELA (PSYS)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:PACHANA
Suffix:
Gender:F
Credentials:PSYS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 ANTELOPE WAY APT 2D
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4436
Mailing Address - Country:US
Mailing Address - Phone:330-591-7876
Mailing Address - Fax:
Practice Address - Street 1:3753 ATTUCKS DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-6080
Practice Address - Country:US
Practice Address - Phone:614-470-4466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP00686103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH15675760OtherCAQH