MEDICARE: MR. TERENCE DONOHUE L.P.C.C.

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	E0003119 SUPV	OH
2	101YM0800X	Mental Health Counselor	E0003119 SUPV	OH
3	101YP2500X	Professional Counselor	E0003119 SUPV	OH

General Provider Information

NPI Number	:	1306277637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TERENCE DONOHUE L.P.C.C.

Provider Business Mailing Address
First Line	:	1364 S HIGH ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43207-1042
Country	:	US
Telephone Number	:	614-445-0352
Fax Number	:	614-445-0121

Provider Business Practice Location Address
First Line	:	1364 S HIGH ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43207-1042
Country	:	US
Telephone Number	:	614-445-0352
Fax Number	:	614-445-0121

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2013
Last Update Date	:	12/12/2013

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