MEDICARE: MS. YOLANDA D TINSLEY LCDCIII

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	091067	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	091067	OTHER	OH	CHEMOICAL DEPENDENCY LICENSE

General Provider Information

NPI Number	:	1427411529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. YOLANDA D TINSLEY LCDCIII

Provider Business Mailing Address
First Line	:	1102 SALEM AVE APT 3D
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45406-5102
Country	:	US
Telephone Number	:	937-901-7408
Fax Number	:

Provider Business Practice Location Address
First Line	:	1102 SALEM AVE APT 3D
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45406-5102
Country	:	US
Telephone Number	:	937-901-7408
Fax Number	:

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

Provider Enumeration Date	:	04/05/2016
Last Update Date	:	05/10/2016

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