Basic Information
| Provider Information | |||||||||
| NPI: | 1487293080 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TIELL | ||||||||
| FirstName: | JULIA | ||||||||
| MiddleName: | ARLENE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | SWT | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 527 S HIGH ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432155602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142279444 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 527 S HIGH ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432155602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402608300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2019 | ||||||||
| LastUpdateDate: | 03/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 03/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S1901217-TRNE | OH | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | S.2106597 | OH | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 172V00000X | S.2106597 | OH | N | Other Service Providers | Community Health Worker | 104100000X | S.2106597 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.