Provider Demographics
NPI:1164797429
Name:TABLER, TINA M (LICDC, LPC)
Entity Type:Individual
Prefix:MISS
First Name:TINA
Middle Name:M
Last Name:TABLER
Suffix:
Gender:F
Credentials:LICDC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1501
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44309-1501
Mailing Address - Country:US
Mailing Address - Phone:330-535-8116
Mailing Address - Fax:330-535-8116
Practice Address - Street 1:15 FREDERICK AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-2904
Practice Address - Country:US
Practice Address - Phone:330-996-7730
Practice Address - Fax:330-996-7730
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-19
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0800514101YP2500X
OHLICDC.161375101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1164797429Medicaid