Basic Information
| Provider Information | |||||||||
| NPI: | 1790754166 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STILLION | ||||||||
| FirstName: | TAMMY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MA, PCC-S, LICDC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2845 BELL ST | ||||||||
| Address2: | |||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437011720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404549766 | ||||||||
| FaxNumber: | 7405886452 | ||||||||
| Practice Location | |||||||||
| Address1: | 44020 MARIETTA RD | ||||||||
| Address2: | |||||||||
| City: | CALDWELL | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437249124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407325233 | ||||||||
| FaxNumber: | 7407324777 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2006 | ||||||||
| LastUpdateDate: | 07/10/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | LICDC.161637 | OH | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | E3825 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 307825 | 01 | OH | TRICARE/MHN PIN | OTHER | 0180823 | 05 | OH | MEDICAID | 543524000 | 01 | OH | MAGELLAN PIN | OTHER | Y03725 | 01 | OH | THE HEALTH PLAN PIN | OTHER | 000000344102 | 01 | OH | ANTHEM PIN | OTHER | 7066609 | 01 | OH | AETNA PIN | OTHER | 377001 | 01 | OH | MOUNT CARMEL PIN | OTHER |