Healthcare Provider Details

I. General information

NPI: 1902403231
Provider Name (Legal Business Name): TAYLOR M. THARP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 BILLINGSLEY RD
COLUMBUS OH
43235-5978
US

IV. Provider business mailing address

10359 HINTON MILL RD
MARYSVILLE OH
43040-8657
US

V. Phone/Fax

Practice location:
  • Phone: 614-738-8646
  • Fax:
Mailing address:
  • Phone: 614-738-8646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAYLOR THARP
Title or Position: THERAPIST
Credential: LISW-S, LICDC
Phone: 614-738-8646