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NPI Code Detail

MEDICARE: BRITTANY TEA LCDCIII

MEDICARE: BRITTANY TEA 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
1101YA0400XAddiction (Substance Use Disorder) Counselor170495OH
2101YA0400XAddiction (Substance Use Disorder) CounselorLCDCIII.162442OH

General Provider Information

NPI Number : 1669077079
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRITTANY TEA LCDCIII
Provider Business Mailing Address
First Line : 4600 MONTGOMERY RD STE 400
Second Line :
City : CINCINNATI
State : OH
Zip : 45212-2600
Country : US
Telephone Number : 833-510-4357
Fax Number : 866-460-2997
Provider Business Practice Location Address
First Line : 1012 E PERKINS AVE
Second Line :
City : SANDUSKY
State : OH
Zip : 44870-5070
Country : US
Telephone Number : 833-510-4357
Fax Number : 866-460-2997
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2020
Last Update Date : 03/03/2026

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