Provider Demographics
NPI:1265733885
Name:HOLISTIC PSYCHIATRY AND ANTI-AGING MEDICINE LLC
Entity type:Organization
Organization Name:HOLISTIC PSYCHIATRY AND ANTI-AGING MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:RINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-596-8599
Mailing Address - Street 1:2939 KENNY RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2406
Mailing Address - Country:US
Mailing Address - Phone:740-403-2672
Mailing Address - Fax:614-457-0834
Practice Address - Street 1:2939 KENNY RD
Practice Address - Street 2:SUITE 180
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2406
Practice Address - Country:US
Practice Address - Phone:740-403-2672
Practice Address - Fax:614-457-0834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.044652174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1710077664OtherEIN