Healthcare Provider Details

I. General information

NPI: 1366957003
Provider Name (Legal Business Name): TCP OF OHIO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2017
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8479 S. MASON MONTGOMERY ROAD SUITE 4
MASON OH
45040-4023
US

IV. Provider business mailing address

8479 S. MASON MONTGOMERY ROAD SUITE 4
MASON OH
45040-4023
US

V. Phone/Fax

Practice location:
  • Phone: 513-443-2180
  • Fax: 513-725-1141
Mailing address:
  • Phone: 513-443-2180
  • Fax: 513-725-1141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. STEFANIE ANN LORENTZ
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 513-413-1203