Provider Demographics
NPI:1629687157
Name:ACCESS BEHAVIORAL LLC
Entity Type:Organization
Organization Name:ACCESS BEHAVIORAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SRINIVAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PONNERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-373-4202
Mailing Address - Street 1:4725 PARKWICK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-6401
Mailing Address - Country:US
Mailing Address - Phone:614-655-3354
Mailing Address - Fax:614-317-4692
Practice Address - Street 1:4725 PARKWICK DR STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-6401
Practice Address - Country:US
Practice Address - Phone:614-655-3354
Practice Address - Fax:614-317-4692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty