Provider Demographics
NPI:1609413848
Name:WELL WITHIN, LLC
Entity Type:Organization
Organization Name:WELL WITHIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLUM
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:614-507-1988
Mailing Address - Street 1:15 BISHOP DR STE 204
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-2276
Mailing Address - Country:US
Mailing Address - Phone:614-392-5933
Mailing Address - Fax:614-474-1515
Practice Address - Street 1:15 BISHOP DR STE 204
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2276
Practice Address - Country:US
Practice Address - Phone:614-293-5933
Practice Address - Fax:614-474-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-06
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0123278Medicaid