Provider Demographics
NPI:1801190137
Name:AXIS BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:AXIS BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:HARGETT
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:614-833-6900
Mailing Address - Street 1:647 HILL RD N
Mailing Address - Street 2:UNIT B
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-9168
Mailing Address - Country:US
Mailing Address - Phone:614-833-6900
Mailing Address - Fax:614-833-6903
Practice Address - Street 1:647 HILL RD N
Practice Address - Street 2:UNIT B
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-9168
Practice Address - Country:US
Practice Address - Phone:614-833-6900
Practice Address - Fax:614-833-6903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-30
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0001639251S00000X
2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty