Provider Demographics
NPI:1275080459
Name:TABONO CENTER FOR WELLBEING INC
Entity Type:Organization
Organization Name:TABONO CENTER FOR WELLBEING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEISGANG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:513-871-7285
Mailing Address - Street 1:4217 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-4107
Mailing Address - Country:US
Mailing Address - Phone:513-871-7285
Mailing Address - Fax:513-871-7281
Practice Address - Street 1:4217 SMITH RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212
Practice Address - Country:US
Practice Address - Phone:513-871-7285
Practice Address - Fax:513-871-7281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6165103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty