MEDICARE: TERRACE COUNSELING SERVICES, INC.

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
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1174164495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERRACE COUNSELING SERVICES, INC.

Provider Business Mailing Address
First Line	:	1122 HERSCHEL AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-3113
Country	:	US
Telephone Number	:	513-545-1201
Fax Number	:

Provider Business Practice Location Address
First Line	:	1122 HERSCHEL AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-3113
Country	:	US
Telephone Number	:	513-545-1201
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RICHARD CARL GILMAN
Credential	:	PH.D., MBA
Telephone Number	:	513-545-1201

Provider Enumeration Date	:	10/08/2019
Last Update Date	:	10/08/2019

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