1790754166 NPI number — TAMMY J STILLION MA, PCC-S, LICDC

Table of content: TAMMY J STILLION MA, PCC-S, LICDC (NPI 1790754166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790754166 NPI number — TAMMY J STILLION MA, PCC-S, LICDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STILLION
Provider First Name:
TAMMY
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, PCC-S, LICDC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790754166
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2845 BELL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ZANESVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43701-1720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-454-9766
Provider Business Mailing Address Fax Number:
740-588-6452

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44020 MARIETTA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CALDWELL
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43724-9124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-732-5233
Provider Business Practice Location Address Fax Number:
740-732-4777
Provider Enumeration Date:
03/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  LICDC.161637 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: E3825 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 307825 . This is a "TRICARE/MHN PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0180823 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 543524000 . This is a "MAGELLAN PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: Y03725 . This is a "THE HEALTH PLAN PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000344102 . This is a "ANTHEM PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 7066609 . This is a "AETNA PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 377001 . This is a "MOUNT CARMEL PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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