Provider Demographics
NPI:1043480627
Name:TIEMAN, DAVID J (LPCC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:TIEMAN
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 RESEARCH PARK DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45432-2851
Mailing Address - Country:US
Mailing Address - Phone:937-427-3837
Mailing Address - Fax:937-427-4516
Practice Address - Street 1:1321 RESEARCH PARK DR
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2851
Practice Address - Country:US
Practice Address - Phone:937-427-3837
Practice Address - Fax:937-427-4516
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0003164 SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health