Basic Information
| Provider Information | |||||||||
| NPI: | 1164417440 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MENTZER | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LISW BCD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13136 SUMMERFIELD WAY | ||||||||
| Address2: | |||||||||
| City: | PICKERINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431479232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148618028 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1495 MORSE RD | ||||||||
| Address2: | STE B-3 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432296478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142677003 | ||||||||
| FaxNumber: | 6142677013 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | I521 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.