Provider Demographics
NPI:1023574076
Name:TOLLER, DAVID EDWARD JR (MS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:EDWARD
Last Name:TOLLER
Suffix:JR
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 JAMES BOHANAN DR
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-2300
Mailing Address - Country:US
Mailing Address - Phone:937-726-0179
Mailing Address - Fax:
Practice Address - Street 1:300 JAMES BOHANAN DR
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-2300
Practice Address - Country:US
Practice Address - Phone:937-742-7516
Practice Address - Fax:937-415-0152
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0800121101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional