Provider Demographics
NPI:1588932503
Name:COLUMBUS STATE UNIVERSITY
Entity type:Organization
Organization Name:COLUMBUS STATE UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:CPMSM
Authorized Official - Phone:469-735-4555
Mailing Address - Street 1:PO BOX 168007
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75016-8007
Mailing Address - Country:US
Mailing Address - Phone:469-735-4555
Mailing Address - Fax:469-735-4640
Practice Address - Street 1:4225 UNIVERSITY AVE
Practice Address - Street 2:SCHUSTER CENTER
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-5679
Practice Address - Country:US
Practice Address - Phone:706-507-8740
Practice Address - Fax:706-507-8753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty