Healthcare Provider Details

I. General information

NPI: 1215907472
Provider Name (Legal Business Name): THOMPKINS CHILD AND ADOLESCENT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 WATSON AVE
BYESVILLE OH
43723-0185
US

IV. Provider business mailing address

211 WATSON AVE P.O. BOX 185
BYESVILLE OH
43723-0185
US

V. Phone/Fax

Practice location:
  • Phone: 740-685-2000
  • Fax: 740-685-2001
Mailing address:
  • Phone: 740-685-2000
  • Fax: 740-685-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0122
License Number StateOH

VIII. Authorized Official

Name: MRS. NANCY LEE YERIAN
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 740-685-2000