Healthcare Provider Details

I. General information

NPI: 1679495808
Provider Name (Legal Business Name): BSI GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11568 W TOWNSHIP ROAD 84
FOSTORIA OH
44830-9589
US

IV. Provider business mailing address

11568 W TOWNSHIP ROAD 84
FOSTORIA OH
44830-9589
US

V. Phone/Fax

Practice location:
  • Phone: 567-278-2713
  • Fax: 567-200-8489
Mailing address:
  • Phone: 567-278-2713
  • Fax: 567-200-8489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE TIELL
Title or Position: OWNER
Credential: DNP, PMHNP-C FNP-C
Phone: 567-278-2713