Provider Demographics
NPI:1841698669
Name:NORTHWOODS CLINIC, LLC
Entity type:Organization
Organization Name:NORTHWOODS CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-841-9763
Mailing Address - Street 1:92 NORTHWOODS BLVD STE C1
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4720
Mailing Address - Country:US
Mailing Address - Phone:614-841-9763
Mailing Address - Fax:614-846-1034
Practice Address - Street 1:92 NORTHWOODS BLVD STE C1
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4720
Practice Address - Country:US
Practice Address - Phone:614-841-9763
Practice Address - Fax:614-846-1034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-10
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.0054632084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty