Provider Demographics
NPI:1033942321
Name:ONE MORE LIGHT WELLNESS
Entity type:Organization
Organization Name:ONE MORE LIGHT WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LEAD CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:D
Authorized Official - Last Name:KRUPPA
Authorized Official - Suffix:
Authorized Official - Credentials:LISW, LICDC
Authorized Official - Phone:614-519-4665
Mailing Address - Street 1:4844 BELLANN RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-5506
Mailing Address - Country:US
Mailing Address - Phone:614-519-4665
Mailing Address - Fax:
Practice Address - Street 1:4844 BELLANN RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-5506
Practice Address - Country:US
Practice Address - Phone:614-519-4665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-22
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0474020Medicaid