Healthcare Provider Details

I. General information

NPI: 1518452135
Provider Name (Legal Business Name): BETH MOORE TJOLAND LSW, MSW, LICDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 HARRISON AVE
COLUMBUS OH
43215-1346
US

IV. Provider business mailing address

929 HARRISON AVE
COLUMBUS OH
43215-1346
US

V. Phone/Fax

Practice location:
  • Phone: 478-262-5727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162466
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2005642
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: