Provider Demographics
NPI:1033860283
Name:CUSTOMIZED BEHAVIORAL HEALTHCARE
Entity type:Organization
Organization Name:CUSTOMIZED BEHAVIORAL HEALTHCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:LAMONT
Authorized Official - Last Name:RIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:614-664-3175
Mailing Address - Street 1:3244 HENDERSON RD STE 4
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-7300
Mailing Address - Country:US
Mailing Address - Phone:614-664-3175
Mailing Address - Fax:614-386-1692
Practice Address - Street 1:3244 HENDERSON RD STE 4
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-7300
Practice Address - Country:US
Practice Address - Phone:614-664-3175
Practice Address - Fax:614-386-1692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty