Provider Demographics
NPI:1285266445
Name:MANTRA MENTAL HEALTH, LLC
Entity type:Organization
Organization Name:MANTRA MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-707-4488
Mailing Address - Street 1:4041 N HIGH ST STE 300H
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3200
Mailing Address - Country:US
Mailing Address - Phone:614-984-4394
Mailing Address - Fax:
Practice Address - Street 1:4041 N HIGH ST STE 300H
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3200
Practice Address - Country:US
Practice Address - Phone:614-984-4394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-06
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0413879Medicaid
OH1473276Medicaid
OH0472290Medicaid
OH0264054Medicaid
OH0268947Medicaid