Healthcare Provider Details

I. General information

NPI: 1841659836
Provider Name (Legal Business Name): NATHAN KING TOOPS LISW-S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2016
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

657 S OHIO AVE
COLUMBUS OH
43205-2743
US

IV. Provider business mailing address

657 S OHIO AVE
COLUMBUS OH
43205-2743
US

V. Phone/Fax

Practice location:
  • Phone: 614-258-8043
  • Fax: 614-258-8123
Mailing address:
  • Phone: 614-258-8043
  • Fax: 614-258-8123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI 0029830 SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: