Provider Demographics
NPI:1336677962
Name:TOLAN, PETER GERMAIN (MS)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:GERMAIN
Last Name:TOLAN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 SEVEN MILE DR
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-1423
Mailing Address - Country:US
Mailing Address - Phone:330-440-8552
Mailing Address - Fax:
Practice Address - Street 1:834 E HIGH AVE
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-3052
Practice Address - Country:US
Practice Address - Phone:330-308-9939
Practice Address - Fax:330-308-9939
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH88103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool