Healthcare Provider Details

I. General information

NPI: 1639954910
Provider Name (Legal Business Name): TINGMING YUAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 08/28/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DORCHESTER SQ N STE 102
WESTERVILLE OH
43081-7305
US

IV. Provider business mailing address

1030 GALLITON CT APT F
COLUMBUS OH
43220-3561
US

V. Phone/Fax

Practice location:
  • Phone: 614-890-8262
  • Fax: 614-776-5333
Mailing address:
  • Phone: 972-693-3148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2305334
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: