Raakhee Bansal Gonela, PSY.D., LICDC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

P.08674 Issued in OH

Practice address

1649 Brice Rd Ste a
Reynoldsburg, OH 43068-2796

Phone

(614) 864-3434

NPI assigned

Dec 20, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1513728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722902400000",
    "number": "1194231589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1649 BRICE RD STE A",
            "city": "REYNOLDSBURG",
            "state": "OH",
            "postal_code": "430682796",
            "telephone_number": "614-864-3434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1649 BRICE RD STE A",
            "city": "REYNOLDSBURG",
            "state": "OH",
            "postal_code": "430682796",
            "telephone_number": "614-864-3434"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10330 Sawmill Pkwy Ste 400",
            "address_purpose": "LOCATION",
            "city": "Powell",
            "state": "OH",
            "postal_code": "430657794",
            "country_code": "US",
            "telephone_number": "614-214-9790",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GONELA",
        "first_name": "RAAKHEE",
        "middle_name": "BANSAL",
        "name_prefix": "Dr.",
        "credential": "PSY.D., LICDC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-12-20",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OH",
            "license": "P.08674",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Reynoldsburg, OH
• Providers in Reynoldsburg, OH by specialty
• Clinical Psychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.