Basic Information
Provider Information
NPI: 1245363548
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ANDREWS
FirstName: TAMI
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: MSW,LISW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 715194
Address2:  
City: COLUMBUS
State: OH
PostalCode: 432715194
CountryCode: US
TelephoneNumber: 6143558004
FaxNumber: 6143550509
Practice Location
Address1: 495 E MAIN ST
Address2:  
City: COLUMBUS
State: OH
PostalCode: 432155349
CountryCode: US
TelephoneNumber: 6143558004
FaxNumber: 6143550509
Other Information
ProviderEnumerationDate: 03/14/2007
LastUpdateDate: 01/05/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XS0026560OHN Behavioral Health & Social Service ProvidersSocial WorkerClinical
1041C0700XI.0700183-SUPVOHY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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