Healthcare Provider Details

I. General information

NPI: 1083129282
Provider Name (Legal Business Name): TERRANCE TILFORD LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 REGENT ST STE 200
COLUMBUS OH
43219-6229
US

IV. Provider business mailing address

4200 REGENT ST STE 200
COLUMBUS OH
43219-6229
US

V. Phone/Fax

Practice location:
  • Phone: 614-845-1147
  • Fax:
Mailing address:
  • Phone: 614-845-1147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2102336
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.1700837
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: