Provider Demographics
NPI:1194333286
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 1:15047 STATE ROUTE 309
Mailing Address - Street 2:
Mailing Address - City:KENTON
Mailing Address - State:OH
Mailing Address - Zip Code:43326-9701
Mailing Address - Country:US
Mailing Address - Phone:419-673-0595
Mailing Address - Fax:
Practice Address - Street 1:15047 STATE ROUTE 309
Practice Address - Street 2:
Practice Address - City:KENTON
Practice Address - State:OH
Practice Address - Zip Code:43326-9701
Practice Address - Country:US
Practice Address - Phone:419-673-0595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACCESS BEHAVIORAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty