Provider Demographics
NPI:1003571985
Name:BACH, THOMAS JEROME (MS, LICDC-CS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JEROME
Last Name:BACH
Suffix:
Gender:M
Credentials:MS, LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3678 JESSUP RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-6032
Mailing Address - Country:US
Mailing Address - Phone:513-390-5497
Mailing Address - Fax:513-629-2311
Practice Address - Street 1:1617 READING RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-1413
Practice Address - Country:US
Practice Address - Phone:513-563-2366
Practice Address - Fax:513-629-2311
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.965593101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)