Organization Active NPI

Real Psychological Services

  • Counseling Psychologist
  • Columbus, OH
National Provider Identifier
1972314151
Registry record updated Aug 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
Legal business name
REAL PSYCHOLOGICAL SERVICES
Practice address
630 E Broad St
Columbus, OH 43215-3999
Phone
(614) 618-5955
Fax
(614) 618-5956
NPI assigned
Jan 16, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2025

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

Authorized official

Name
Dwight David TolliverNPI 1609909753
Title
Executive Director
Phone
(614) 618-5955

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC1900X Primary

Addresses

Primary practice location

630 E Broad St
Columbus, OH 43215-3999

Mailing address

630 E Broad St
Columbus, OH 43215-3999
Phone (614) 618-5955

Other practice location 1

6500 Rolling Hills Ln E
Grove City, OH 43123-9787
Phone (614) 937-2844

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250331002751 OH Part B Supplier - Clinic/Group Practice 2567985559 Receives reassigned benefits from 2 practitioners
Practice locations: Columbus, OH

National Provider Directory

National Provider Directory

Locations

630 E Broad St
Columbus, OH 43215
Phone (614) 565-4210

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1736985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755648000000",
    "number": "1972314151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 E BROAD ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432153999",
            "telephone_number": "614-618-5955",
            "fax_number": "614-618-5956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 E BROAD ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432153999",
            "telephone_number": "614-618-5955",
            "fax_number": "614-618-5956"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6500 Rolling Hills Ln E",
            "address_purpose": "LOCATION",
            "city": "Grove City",
            "state": "OH",
            "postal_code": "431239787",
            "country_code": "US",
            "telephone_number": "614-937-2844",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "REAL PSYCHOLOGICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-16",
        "last_updated": "2025-08-20",
        "certification_date": "2025-08-20",
        "status": "A",
        "authorized_official_last_name": "TOLLIVER",
        "authorized_official_first_name": "DWIGHT",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "614-618-5955"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2025; 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.