| Koolkidspirtion Mentor Ship Program | |
|
1496 Brice Rd Reynoldsburg OH 43068-2341 | |
| (614) 965-5163 | |
| Not Available |
| Full Name | Koolkidspirtion Mentor Ship Program |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1496 Brice Rd, Reynoldsburg, Ohio |
| Authorized Official Name and Position | Tracy Kane (CEO) |
| Authorized Official Contact | 6149655163 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Koolkidspirtion Mentor Ship Program 1496 Brice Rd Reynoldsburg OH 43068-2341 Ph: (614) 965-5163 | Koolkidspirtion Mentor Ship Program 1496 Brice Rd Reynoldsburg OH 43068-2341 Ph: (614) 965-5163 |
| NPI Number | 1528943701 |
|---|---|
| Provider Enumeration Date | 08/07/2025 |
| Last Update Date | 08/07/2025 |
| Certification Date | 08/07/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528943701 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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