=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679495808
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BSI GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2026
-----------------------------------------------------
Last Update Date | 07/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11568 W TOWNSHIP ROAD 84
-----------------------------------------------------
City | FOSTORIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44830-9589
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 567-278-2713
-----------------------------------------------------
Fax | 567-200-8489
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11568 W TOWNSHIP ROAD 84
-----------------------------------------------------
City | FOSTORIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44830-9589
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 567-278-2713
-----------------------------------------------------
Fax | 567-200-8489
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | STEPHANIE TIELL
-----------------------------------------------------
Credential | DNP, PMHNP-C FNP-C
-----------------------------------------------------
Telephone | 567-278-2713
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------