Healthcare Provider Details

I. General information

NPI: 1922935477
Provider Name (Legal Business Name): JAMIE THEIS CT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 PARK MEADOW RD STE H
WESTERVILLE OH
43081-2876
US

IV. Provider business mailing address

623 PARK MEADOW RD STE H
WESTERVILLE OH
43081-2876
US

V. Phone/Fax

Practice location:
  • Phone: 614-948-3273
  • Fax: 855-740-2025
Mailing address:
  • Phone: 614-948-3273
  • Fax: 855-740-2025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2607644-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: