Provider Demographics
NPI:1497701395
Name:BACHMAN, KARL THOMAS (PHD)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:THOMAS
Last Name:BACHMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 BETHEL RD STE 104
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2773
Mailing Address - Country:US
Mailing Address - Phone:614-596-4384
Mailing Address - Fax:877-755-7668
Practice Address - Street 1:1161 BETHEL RD STE 104
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2773
Practice Address - Country:US
Practice Address - Phone:614-596-4384
Practice Address - Fax:877-755-7668
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2019-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2699103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0397888Medicaid
OH0397888Medicaid