Provider Demographics
NPI:1245635549
Name:TALBOT CLINICAL SERVICES OF OHIO LLC
Entity type:Organization
Organization Name:TALBOT CLINICAL SERVICES OF OHIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WIEBER
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:567-343-1966
Mailing Address - Street 1:732 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43605-2397
Mailing Address - Country:US
Mailing Address - Phone:419-509-7422
Mailing Address - Fax:419-691-0601
Practice Address - Street 1:732 MAIN ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43605-2397
Practice Address - Country:US
Practice Address - Phone:833-762-1013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-29
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0208677Medicaid