| Larue Psychiatric Services Llc | |
|
415 E Broad St Ste 112b Columbus OH 43215-3800 | |
| (614) 208-4293 | |
| (888) 858-4293 |
| Full Name | Larue Psychiatric Services Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 415 E Broad St Ste 112b, Columbus, Ohio |
| Authorized Official Name and Position | Khalilah Krystal Larue (CERTFIED NURSE PRACTITIONER) |
| Authorized Official Contact | 6146682149 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Larue Psychiatric Services Llc 1710 Sugarloaf Club Dr Duluth GA 30097-7456 Ph: (614) 668-2149 | Larue Psychiatric Services Llc 415 E Broad St Ste 112b Columbus OH 43215-3800 Ph: (614) 208-4293 |
| NPI Number | 1396276432 |
|---|---|
| Provider Enumeration Date | 03/21/2017 |
| Last Update Date | 08/27/2022 |
| Certification Date | 08/27/2022 |
| Medicare PECOS PAC ID | 8921385139 |
|---|---|
| Medicare Enrollment ID | O20170425002646 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396276432 | NPI | - | NPPES |
| 003260122B | Medicaid | GA | |
| 0076744 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 10483 (Ohio) | Primary |
| Provider Name | Khalilah K Larue |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255578548 PECOS PAC ID: 7315123692 Enrollment ID: I20110523000041 |
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