Madison, Tyleeta J
Madison, Tyleeta J is an sole proprietor health care provider with primary practice located at 2115 W Park Dr , Lorain OH 44053-1138. She recently has only one registered license in Behavioral Health & Social Service Providers / Counselor, which is considered as her primary health care specialty. Madison, Tyleeta J can be contacted via phone (440) 989-4900.Contact Information
Primary practice address
2115 W Park Dr
Lorain OH 44053-1138
Phone: (440) 989-4900
Fax: (440) 282-4779
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Counselor | 101Y00000X | CDCA.171102 | Ohio |
Profile Details
| NPI number | 1164065256 |
|---|---|
| LBN Legal business name | Madison, Tyleeta J |
| Credentials | CDCA |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 22nd, 2019 |
| Last updated | Oct 22nd, 2019 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1164065256 | NPPES |
| Ohio | Other | CDCA.171102 | LICENSE |
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