White Light Behavioral Heath Columbus, LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

WHITE LIGHT BEHAVIORAL HEATH COLUMBUS, LLC

Practice address

4040 E Broad St
Columbus, OH 43213-1156

Phone

(615) 775-1931

NPI assigned

Sep 6, 2022

Organization subpart

No

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

Authorized official

Name

Mrs. Laurie Boudreau

Title

Chief of Staff

Phone

(617) 839-0925

Specialties & licenses 4

Addresses

Tax ID family

White Light Behavioral Health Columbus2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• White Light Behavioral Heath Columbus, LLC

  • Adult Mental Health Clinic/Center
  • Columbus, OH
  • NPI 1295573921
  NPD tax ID

Locations

Practitioners 1

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

• Ryan John Wakim, M.D.

  • Psychiatry Physician
  • Wheeling, WV
  • NPI 1093033789
  NPD (past)

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

{
    "created_epoch": "1662422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693353600000",
    "number": "1194446476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4040 E BROAD ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432131156",
            "telephone_number": "614-350-4010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4040 E BROAD ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432131156",
            "telephone_number": "615-775-1931"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4300 E Broad St Ste 300",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432131243",
            "country_code": "US",
            "telephone_number": "614-350-4010",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WHITE LIGHT BEHAVIORAL HEATH COLUMBUS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-06",
        "last_updated": "2023-08-30",
        "certification_date": "2023-08-30",
        "status": "A",
        "authorized_official_last_name": "BOUDREAU",
        "authorized_official_first_name": "LAURIE",
        "authorized_official_title_or_position": "CHIEF OF STAFF",
        "authorized_official_telephone_number": "617-839-0925",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holly Lynn Whitaker, L.P.N
• Julie Kay Whitaker
• Todd E Whitaker, MD
• Gretchen Whitby, CNP
• Sandra Lee Whitcraft, RNFA
• White Light Behavioral Heath Columbus, LLC
• Hattie White-Henry
• Raigan White-Walters
• Abigail White
• Aisha J White, MD

• Substance Abuse Rehabilitation Facility in Columbus, OH
• Providers in Columbus, OH by specialty
• Substance Abuse Rehabilitation Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2023; 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.