Provider Demographics
NPI:1518608595
Name:THIEL, ELIZABETH ANN (MS, MED)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:THIEL
Suffix:
Gender:F
Credentials:MS, MED
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:POLLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, MED
Mailing Address - Street 1:10738 PLEASANT KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3667
Mailing Address - Country:US
Mailing Address - Phone:614-743-1054
Mailing Address - Fax:
Practice Address - Street 1:10738 PLEASANT KNOLL DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3667
Practice Address - Country:US
Practice Address - Phone:614-743-1054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2202825101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional