LICKING MEMORIAL PROFESSIONAL CORP. (NPI# 1295809614) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295809614 |
| Entity Type | Organization |
| Organization Name | LICKING MEMORIAL PROFESSIONAL CORP. |
| Other Organization Name | LICKING MEMORIAL BEHAVIORAL HEALTH PATASKALA |
| Practice Address |
1 Healthy Pl Suite 105 Pataskala OH 43062-7067 |
| Practice Telephone | 7403481930 |
| Practice Fax Number | 7403481931 |
| Mailing Telephone | 7403481930 |
| Mailing Fax Number | 7403481931 |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | ROBERT MONTAGNESE (EXECUTIVE VICE PRESIDENT) |
| Authorized Official Telephone | 7403484000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Licking Memorial Behavioral Health Pataskala | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235311358 | Licking Memorial Professional Corp. | Family Medicine | 17 Forry St, Newark, OH 43055-4004 | 2007-11-30 |
| 1497771521 | Licking Memorial Professional Corp. | Pediatrics | 240 N. Main St, Utica, OH 43080 | 2006-07-14 |
| 1689690661 | Licking Memorial Professional Corp. | Family Medicine | 96 Integrity Drive, H., Hebron, OH 43025 | 2006-07-14 |
| 1487688545 | Licking Memorial Professional Corp. | Family Medicine | 687 Hopewell Dr, Suite2, Heath, OH 43056-1579 | 2006-07-11 |
| 1598945818 | Licking Memorial Professional Corp. | Family Medicine | 717 S 30th St, Newark, OH 43056-1244 | 2007-11-05 |
| 1669547824 | Licking Memorial Professional Corp. | Pediatrics | 399 E Main St, Newark, OH 43055-6516 | 2006-11-22 |
| 1154496503 | Licking Memorial Professional Corp. | General Practice | 2000 Tamarack Rd, Newark, OH 43055 | 2006-11-21 |
| 1649290073 | Licking Memorial Professional Corp. | Internal Medicine | 120 Mcmillen Dr, Newark, OH 43055-1809 | 2006-07-20 |
| 1326068768 | Licking Memorial Professional Corp. | Internal Medicine | 1320 West Main Street, Newark, OH 43055-1822 | 2006-07-20 |
| 1235159674 | Licking Memorial Professional Corp. | Obstetrics & Gynecology | 1 Healthy Pl, Suite 103, Pataskala, OH 43062-7067 | 2006-07-20 |
| Street Address |
1 HEALTHY PL SUITE 105 |
| City | PATASKALA |
| State | OH |
| Zip Code | 43062-7067 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427056597 | John Applegate | Pediatrics | 1 Healthy Pl, Ste. 203, Pataskala, OH 43062-7067 | 2005-07-12 |
| 1700291416 | Licking Memorial Professional Corporation | Dermatology | 1 Healthy Pl, Suite 205, Pataskala, OH 43062-7067 | 2014-06-23 |
| 1952479115 | Connie S Jenkins | Psychiatry & Neurology | 1 Healthy Pl, Suite 105, Pataskala, OH 43062-7067 | 2006-12-04 |
| 1235159674 | Licking Memorial Professional Corp. | Obstetrics & Gynecology | 1 Healthy Pl, Suite 103, Pataskala, OH 43062-7067 | 2006-07-20 |
| 1144240581 | Licking Memorial Professional Corp. | Pediatrics | 1 Healthy Pl, Ste 203, Pataskala, OH 43062 | 2006-07-20 |
| 1851325526 | Licking Memorial Professional Corp | Family Medicine | 1 Healthy Pl, Suite 101, Pataskala, OH 43062-7067 | 2006-07-10 |
| 1104869700 | Tiffany E.d. Inglis | Obstetrics & Gynecology | 1 Healthy Pl, Suite 201, Pataskala, OH 43062-7067 | 2006-06-13 |
| 1942249735 | Dalia S Elkhairi | Obstetrics & Gynecology | 1 Healthy Pl, Suite 201, Pataskala, OH 43062-7067 | 2006-06-06 |
| 1255330965 | Colleen Smith | Family Medicine | 1 Healthy Pl, Suite 101, Pataskala, OH 43062-7067 | 2005-07-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255955639 | 1st and Long Logistics Ltd. | Private Vehicle | 104 Eastave, Pataskala, OH 43062 | 2020-06-02 |
| 1023639168 | Jodi C Neff | Driver | 104 East Ave, Etna, OH 43062 | 2020-04-29 |
| 1073022596 | Bonny Lou Harris | Licensed Vocational Nurse | 8764 National Rd Sw Lot 43, Pataskala, OH 43062 | 2017-09-27 |
| 1780131359 | Patricia Obrien | Licensed Practical Nurse | 4606 Brownstone Drive, Hilliard, OH 43062 | 2016-09-01 |
| 1477941615 | Keli R Massie | Speech-Language Pathologist | 391 S. High Street, Pataskala, OH 43062 | 2014-12-22 |
| 1952709016 | Stacey Heldman | Speech-Language Pathologist | 927b South St., Etna, OH 43062 | 2014-12-05 |
| 1033541842 | Power Ahead Physical Therapy LLC | Physical Therapist | 202 E. Broad St., Pataskala, OH 43062 | 2013-08-02 |
| 1174819288 | Mollie Sue Albaugh | Occupational Therapy Assistant | 14 Milkweed Place, Pataskala, OH 43062 | 2011-06-27 |
| 1710198619 | Jennifer Agnes Skeens | Licensed Practical Nurse | 114 Deer Path Ct N, Pataskala, OH 43062 | 2007-05-24 |
| 1346456357 | Total Renal Care Inc | Clinic/Center | 658 E Broad St, Pataskala, OH 43062 | 2007-05-15 |
| Find all providers in zip 43062 | ||||
| Taxonomy Code | 2084P0800X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Psychiatry |
| A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700493251 | Holly Mycroft | Psychiatry & Neurology | 5603 Congressional Pl Apt F, Hilliard, OH 43026-4308 | 2020-09-29 |
| 1770108698 | Christine Yammarino | Psychiatry & Neurology | 24700 Lorain Rd Ste 303, North Olmsted, OH 44070-2069 | 2020-06-16 |
| 1669003281 | James Roger Nicholas | Psychiatry & Neurology | 11170 Maple Knoll Ter Unit L215, Cincinnati, OH 45246-4154 | 2020-02-02 |
| 1407406697 | New Life Ketamine Clinic LLC | Psychiatry & Neurology | 7905 Schatz Pointe Dr Ste 100, Dayton, OH 45459-3856 | 2019-09-19 |
| 1164081063 | Reynolds Behavioral Health LLC | Psychiatry & Neurology | 1649 N Reynolds Rd, Toledo, OH 43615-3625 | 2019-06-13 |
| 1326509217 | Marian Louise Brown | Psychiatry & Neurology | 14877 Stonehaven Dr, Perrysburg, OH 43551-9537 | 2019-03-25 |
| 1912470303 | Alleviant of Akron | Psychiatry & Neurology | 1000 S Cleveland Massillon Rd Ste 1, Akron, OH 44333-9204 | 2019-01-08 |
| 1710456025 | Wissam Hoteit Md LLC | Psychiatry & Neurology | 4841 Yosemite Pkwy, Sylvania, OH 43560-4341 | 2018-11-15 |
| 1215435367 | Psychiatric Services of Toledo, Inc | Psychiatry & Neurology | 2204 N Reynolds Rd, Toledo, OH 43615-2814 | 2018-01-23 |
| 1720508146 | Keystone Psychiatry, Inc. | Psychiatry & Neurology | 5920-e Wilcox Pl, Dublin, OH 43016-6802 | 2017-06-27 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.