Provider Demographics
NPI:1053005116
Name:KETAMINE HEALTH & WELLNESS CLINICS OF OHIO LLC
Entity type:Organization
Organization Name:KETAMINE HEALTH & WELLNESS CLINICS OF OHIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SEIFFERTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-306-1073
Mailing Address - Street 1:5060 BRADENTON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-3511
Mailing Address - Country:US
Mailing Address - Phone:380-214-1636
Mailing Address - Fax:380-235-7469
Practice Address - Street 1:5060 BRADENTON AVE STE A
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3511
Practice Address - Country:US
Practice Address - Phone:380-214-1636
Practice Address - Fax:380-235-7469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-02
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty