Provider Demographics
NPI:1407035454
Name:JOAN M TIETJEN PHD LTD
Entity Type:Organization
Organization Name:JOAN M TIETJEN PHD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TIETJEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:614-459-4822
Mailing Address - Street 1:3001 BETHEL RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2285
Mailing Address - Country:US
Mailing Address - Phone:614-459-4822
Mailing Address - Fax:614-459-4823
Practice Address - Street 1:3001 BETHEL RD
Practice Address - Street 2:SUITE 207
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2285
Practice Address - Country:US
Practice Address - Phone:614-459-4822
Practice Address - Fax:614-459-4823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSP02551Medicare PIN