Healthcare Provider Details

I. General information

NPI: 1639655707
Provider Name (Legal Business Name): THOMAS M. TAGGART JR. LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10921 REED HARTMAN HWY STE 133
BLUE ASH OH
45242-2851
US

IV. Provider business mailing address

10921 REED HARTMAN HWY STE 133
BLUE ASH OH
45242-2851
US

V. Phone/Fax

Practice location:
  • Phone: 513-984-9838
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.1902138
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: