Provider Demographics
NPI:1720865579
Name:OHIO GAMBLING TELEHEALTH NETWORK
Entity type:Organization
Organization Name:OHIO GAMBLING TELEHEALTH NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-750-9899
Mailing Address - Street 1:355 E CAMPUS VIEW BLVD STE 285
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-5680
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:355 E CAMPUS VIEW BLVD STE 285
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-5680
Practice Address - Country:US
Practice Address - Phone:614-750-9899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-13
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health