MEDICARE: THERAPYOLOGY LLC

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	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639780331
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAPYOLOGY LLC

Provider Business Mailing Address
First Line	:	PO BOX 842
Second Line	:
City	:	WEST UNION
State	:	OH
Zip	:	45693-0842
Country	:	US
Telephone Number	:	937-217-6391
Fax Number	:

Provider Business Practice Location Address
First Line	:	188 PAGE SCHOOL RD
Second Line	:
City	:	WEST UNION
State	:	OH
Zip	:	45693-9344
Country	:	US
Telephone Number	:	937-217-6391
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PSYCHOTHERAPIST
Name	:	HEATHER TOLLE
Credential	:	LISW
Telephone Number	:	937-217-6391

Provider Enumeration Date	:	08/14/2020
Last Update Date	:	08/14/2020

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Directions to “THERAPYOLOGY LLC ” Practice Location

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