Provider Demographics
NPI:1760375778
Name:A & E BEHAVIORAL HEALTHCARE PLLC
Entity type:Organization
Organization Name:A & E BEHAVIORAL HEALTHCARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED INDEPENDENT SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:RUDESTA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS-UGIOMOH
Authorized Official - Suffix:
Authorized Official - Credentials:LISW, MSW
Authorized Official - Phone:509-204-7249
Mailing Address - Street 1:170 NORTHWOODS BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4711
Mailing Address - Country:US
Mailing Address - Phone:509-204-7249
Mailing Address - Fax:
Practice Address - Street 1:170 NORTHWOODS BLVD STE 210
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4711
Practice Address - Country:US
Practice Address - Phone:509-204-7249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-29
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health