MEDICARE: MR. MICHAEL THOMAS HILLMON QMHS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1164386546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL THOMAS HILLMON QMHS

Provider Business Mailing Address
First Line	:	2912 E 14TH AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-2304
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2912 E 14TH AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-2304
Country	:	US
Telephone Number	:	614-323-2628
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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