Basic Information
| Provider Information | |||||||||
| NPI: | 1518452135 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TJOLAND | ||||||||
| FirstName: | BETH | ||||||||
| MiddleName: | MOORE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1440 OMBERSLEY LN APT D | ||||||||
| Address2: | |||||||||
| City: | UPPER ARLINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432213477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145629835 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5665 HOOVER RD | ||||||||
| Address2: | |||||||||
| City: | GROVE CITY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431239122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148752371 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2018 | ||||||||
| LastUpdateDate: | 11/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 101YA0400X | CDCA.169073 | OH | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.