Provider Demographics
NPI:1215907472
Name:THOMPKINS CHILD AND ADOLESCENT SERVICES, INC.
Entity type:Organization
Organization Name:THOMPKINS CHILD AND ADOLESCENT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:YERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-685-2000
Mailing Address - Street 1:211 WATSON AVE
Mailing Address - Street 2:P.O. BOX 185
Mailing Address - City:BYESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43723-0185
Mailing Address - Country:US
Mailing Address - Phone:740-685-2000
Mailing Address - Fax:740-685-2001
Practice Address - Street 1:211 WATSON AVE
Practice Address - Street 2:
Practice Address - City:BYESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43723-0185
Practice Address - Country:US
Practice Address - Phone:740-685-2000
Practice Address - Fax:740-685-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0122101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2847165Medicaid
OH10163Medicare UPIN