Provider Demographics
NPI:1396804456
Name:DARRAH, BETH LEBO (PSYD)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:LEBO
Last Name:DARRAH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:BETH
Other - Middle Name:ERIN
Other - Last Name:LEBO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:4949 OLENTANGY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1926
Mailing Address - Country:US
Mailing Address - Phone:614-451-6606
Mailing Address - Fax:614-451-2923
Practice Address - Street 1:4949 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1926
Practice Address - Country:US
Practice Address - Phone:614-451-6606
Practice Address - Fax:614-451-2923
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7062103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200845030Medicaid
IN200845030Medicaid