Provider Demographics
NPI:1811560899
Name:PROVIDERS FOR HEALTHY LIVING
Entity Type:Organization
Organization Name:PROVIDERS FOR HEALTHY LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-664-3595
Mailing Address - Street 1:3535 FISHINGER BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-2000
Mailing Address - Country:US
Mailing Address - Phone:614-664-3595
Mailing Address - Fax:
Practice Address - Street 1:3535 FISHINGER BLVD STE 110
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-2000
Practice Address - Country:US
Practice Address - Phone:614-664-3595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty