MEDICARE: TELECOUNSEL

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1174398754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TELECOUNSEL

Provider Business Mailing Address
First Line	:	7527 STATE RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45255-6407
Country	:	US
Telephone Number	:	513-245-8970
Fax Number	:

Provider Business Practice Location Address
First Line	:	7527 STATE RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45255-6407
Country	:	US
Telephone Number	:	513-245-8970
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HIBBA AZIZ
Credential	:
Telephone Number	:	513-789-6543

Provider Enumeration Date	:	11/24/2023
Last Update Date	:	11/24/2023

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