Provider Demographics
NPI:1164965273
Name:TALO COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:TALO COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:AYAN
Authorized Official - Middle Name:SHIRE
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:614-532-8187
Mailing Address - Street 1:PO BOX 1307
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-6307
Mailing Address - Country:US
Mailing Address - Phone:614-532-8187
Mailing Address - Fax:
Practice Address - Street 1:2021 E DUBLIN GRANVILLE RD STE 170
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3548
Practice Address - Country:US
Practice Address - Phone:614-532-8187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14513941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0166439Medicaid
OH0165820Medicaid