Provider Demographics
NPI:1740899277
Name:ACCESS BEHAVIORAL LLC
Entity type:Organization
Organization Name:ACCESS BEHAVIORAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SRINIVAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PONNERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-373-4202
Mailing Address - Street 1:250 S HENRY ST
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-2978
Mailing Address - Country:US
Mailing Address - Phone:740-369-4482
Mailing Address - Fax:740-369-4908
Practice Address - Street 1:250 S HENRY ST
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-2978
Practice Address - Country:US
Practice Address - Phone:740-369-4482
Practice Address - Fax:740-369-4908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty