Provider Demographics
NPI:1457754384
Name:PRIME BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:PRIME BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:HARGETT
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC-S
Authorized Official - Phone:614-833-6900
Mailing Address - Street 1:711 N COLUMBUS ST
Mailing Address - Street 2:STE. 100
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-2538
Mailing Address - Country:US
Mailing Address - Phone:740-653-6500
Mailing Address - Fax:740-653-6501
Practice Address - Street 1:647 HILL RD N
Practice Address - Street 2:STE B
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-9168
Practice Address - Country:US
Practice Address - Phone:614-833-6900
Practice Address - Fax:614-833-6903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-06
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH401440Medicare PIN