Professional Behavioral Support LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

PROFESSIONAL BEHAVIORAL SUPPORT LLC

Practice address

691 E Dublin Granville Rd
Columbus, OH 43229-3209

Phone

(614) 715-2154

Fax

(614) 705-6577

NPI assigned

Jul 6, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Elieth Kokwesiga Kamala, CNPNPI 1639343007

Title

Pschiatric Nurse Practictitioner

Phone

(614) 574-1823

Specialties & licenses 1

Addresses

Other names 1

• Professional Behavioral Support LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Elieth Kokwesiga Kamala

  • Psychiatric/Mental Health Nurse Practitioner
  • Columbus, OH
  • NPI 1639343007
  Medicare reassignment NPD Authorized official
• Norman A Schwartz, MD

  • Family Medicine Physician
  • Pataskala, OH
  • NPI 1255322335
  Medicare reassignment NPD
• Elizabeth A. Wadei, APRN FNP-BC, FNP-C

  • Primary Care Nurse Practitioner
  • Columbus, OH
  • NPI 1487958302
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1688601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702080000000",
    "number": "1174201545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "691 E DUBLIN GRANVILLE RD",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432293209",
            "telephone_number": "614-574-1824",
            "fax_number": "614-420-2229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "691 E DUBLIN GRANVILLE RD",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432293209",
            "telephone_number": "614-715-2154",
            "fax_number": "614-705-6577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL BEHAVIORAL SUPPORT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-06",
        "last_updated": "2023-12-09",
        "certification_date": "2023-12-09",
        "status": "A",
        "authorized_official_last_name": "KAMALA",
        "authorized_official_first_name": "ELIETH",
        "authorized_official_middle_name": "KOKWESIGA",
        "authorized_official_title_or_position": "PSCHIATRIC NURSE PRACTICTITIONER",
        "authorized_official_telephone_number": "614-574-1823",
        "authorized_official_credential": "CNP"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Professional Behavioral Support LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Professional Behavioral Support LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Columbus, OH
• Providers in Columbus, OH by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.