MEDICARE: THOMAS EDWARD RATHBUN LPC

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	101YM0800X	Mental Health Counselor	C.2204757	OH

General Provider Information

NPI Number	:	1699459149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS EDWARD RATHBUN LPC

Provider Business Mailing Address
First Line	:	402 WAYNE DR
Second Line	:
City	:	FAIRBORN
State	:	OH
Zip	:	45324-5417
Country	:	US
Telephone Number	:	937-846-6663
Fax Number	:

Provider Business Practice Location Address
First Line	:	5450 FAR HILLS AVE STE 205
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-2346
Country	:	US
Telephone Number	:	937-230-4661
Fax Number	:

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

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	06/14/2023

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