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NPI Code Detail

MEDICARE: MISS TINA M TABLER LICDC, LPC

MEDICARE:  MISS TINA M TABLER  LICDC, LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorC0800514OH
2101YA0400XAddiction (Substance Use Disorder) CounselorLICDC.161375OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164797429
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS TINA M TABLER LICDC, LPC
Provider Business Mailing Address
First Line : PO BOX 1501
Second Line :
City : AKRON
State : OH
Zip : 44309-1501
Country : US
Telephone Number : 330-535-8116
Fax Number : 330-535-8116
Provider Business Practice Location Address
First Line : 15 FREDERICK AVE
Second Line :
City : AKRON
State : OH
Zip : 44310-2904
Country : US
Telephone Number : 330-996-7730
Fax Number : 330-996-7730
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2012
Last Update Date : 02/15/2017

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