Provider Demographics
NPI:1144207283
Name:TAMBORSKI, BETH A (MS PCC SC)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:A
Last Name:TAMBORSKI
Suffix:
Gender:F
Credentials:MS PCC SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 WOODMAN DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45432-3497
Mailing Address - Country:US
Mailing Address - Phone:937-223-1781
Mailing Address - Fax:937-853-0096
Practice Address - Street 1:1320 WOODMAN DR
Practice Address - Street 2:SUITE 200
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45432-3497
Practice Address - Country:US
Practice Address - Phone:937-223-1781
Practice Address - Fax:937-853-0096
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0003091101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2272231Medicare ID - Type Unspecified