Provider Demographics
NPI:1891440848
Name:WESTSIDE MENTAL HEALTH INC
Entity Type:Organization
Organization Name:WESTSIDE MENTAL HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:STUMBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-965-7531
Mailing Address - Street 1:700 BRYDEN RD STE 221
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4839
Mailing Address - Country:US
Mailing Address - Phone:614-965-7531
Mailing Address - Fax:614-991-5892
Practice Address - Street 1:700 BRYDEN RD STE 221
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4839
Practice Address - Country:US
Practice Address - Phone:614-965-7531
Practice Address - Fax:614-991-5892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-18
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH555566Medicaid