Healthcare Provider Details

I. General information

NPI: 1427837442
Provider Name (Legal Business Name): THOMAS ALAN MOYER JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 GERVAIS RD
FRANKLIN FURNACE OH
45629-8742
US

IV. Provider business mailing address

303 GERVAIS RD
FRANKLIN FURNACE OH
45629-8742
US

V. Phone/Fax

Practice location:
  • Phone: 740-259-7000
  • Fax: 740-480-5200
Mailing address:
  • Phone: 740-259-7000
  • Fax: 740-480-5200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number185452
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: