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NPI Code Detail

MEDICARE: TABATA C ALAIN MFT

MEDICARE: TABATA C ALAIN MFT
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
1106H00000XMarriage & Family TherapistM.1500026OH
2106H00000XMarriage & Family TherapistF.2300368OH

General Provider Information

NPI Number : 1386188308
Entity Type Code : Individual
Provider Name (Legal Business Name) : TABATA C ALAIN MFT
Provider Business Mailing Address
First Line : 7031 CORPORATE WAY STE 103
Second Line :
City : DAYTON
State : OH
Zip : 45459-4262
Country : US
Telephone Number : 937-619-9089
Fax Number : 937-328-7257
Provider Business Practice Location Address
First Line : 7031 CORPORATE WAY STE 103
Second Line :
City : DAYTON
State : OH
Zip : 45459-4262
Country : US
Telephone Number : 937-619-9089
Fax Number : 937-328-7257
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2016
Last Update Date : 11/13/2023

Similar Medicare Providers

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Practice Location Address:
7031 CORPORATE WAY STE 103
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1356857403 — DE'ASIA L. THOMPSON, LISW, LLC
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1083192264 — JESSICA DANIELS
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Directions to “ TABATA C ALAIN MFT” Practice Location

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