Provider Demographics
NPI:1881059061
Name:FORUM OHIO, LLC
Entity type:Organization
Organization Name:FORUM OHIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:STINSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD JD LICDC-S ABPP
Authorized Official - Phone:614-309-9727
Mailing Address - Street 1:7440 ROLLING RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8933
Mailing Address - Country:US
Mailing Address - Phone:614-309-9727
Mailing Address - Fax:614-895-6801
Practice Address - Street 1:20 S 3RD ST
Practice Address - Street 2:SUITE 210
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4206
Practice Address - Country:US
Practice Address - Phone:614-309-9727
Practice Address - Fax:614-895-6801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health