MEDICARE: MR. NATHAN KING TOOPS LISW-S

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	I 0029830 SUPV	OH

General Provider Information

NPI Number	:	1841659836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NATHAN KING TOOPS LISW-S

Provider Business Mailing Address
First Line	:	657 S OHIO AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43205-2743
Country	:	US
Telephone Number	:	614-258-8043
Fax Number	:	614-258-8123

Provider Business Practice Location Address
First Line	:	657 S OHIO AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43205-2743
Country	:	US
Telephone Number	:	614-258-8043
Fax Number	:	614-258-8123

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

Provider Enumeration Date	:	02/18/2016
Last Update Date	:	02/18/2016

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