Provider Demographics
NPI:1821779133
Name:BAI, TIANYI (LSW)
Entity Type:Individual
Prefix:
First Name:TIANYI
Middle Name:
Last Name:BAI
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9217 STATE ROUTE 43 STE 220
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-5371
Mailing Address - Country:US
Mailing Address - Phone:330-422-9005
Mailing Address - Fax:
Practice Address - Street 1:9217 STATE ROUTE 43 STE 220
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-5371
Practice Address - Country:US
Practice Address - Phone:330-422-9005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2309481101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health