Healthcare Provider Details

I. General information

NPI: 1275079584
Provider Name (Legal Business Name): QUINTA T TAMBE-EBOT LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 E STATE ST STE 200
COLUMBUS OH
43215-0109
US

IV. Provider business mailing address

1242 WIND ROCK DR
TIPP CITY OH
45371-0017
US

V. Phone/Fax

Practice location:
  • Phone: 574-546-1900
  • Fax: 574-546-1999
Mailing address:
  • Phone: 480-772-1675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2001674
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: