Basic Information
| Provider Information | |||||||||
| NPI: | 1003571985 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BACH | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | JEROME | ||||||||
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| Credential: | MS, LICDC-CS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3678 JESSUP RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452476032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133905497 | ||||||||
| FaxNumber: | 5136292311 | ||||||||
| Practice Location | |||||||||
| Address1: | 1617 READING RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452021413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135632366 | ||||||||
| FaxNumber: | 5136292311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2021 | ||||||||
| LastUpdateDate: | 11/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | LICDC.965593 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.