Provider Demographics
NPI:1740659077
Name:MEGUMI OMONISHI, PH.D. LLC
Entity type:Organization
Organization Name:MEGUMI OMONISHI, PH.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGUMI
Authorized Official - Middle Name:
Authorized Official - Last Name:OMONISHI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:614-766-5500
Mailing Address - Street 1:5100 BRADENTON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-7567
Mailing Address - Country:US
Mailing Address - Phone:614-766-5500
Mailing Address - Fax:614-489-6391
Practice Address - Street 1:5100 BRADENTON AVE STE A
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-7567
Practice Address - Country:US
Practice Address - Phone:614-766-5500
Practice Address - Fax:614-489-6391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6987103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty