Tietbohl, Phillip J.

Tietbohl, Phillip J. is an sole proprietor health care provider with primary practice located at 232 Logan Ave , Wyomissing PA 19610-2673. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Psychologist, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Tietbohl, Phillip J. can be contacted via phone (610) 741-9776.

Contact Information

Primary practice address
232 Logan Ave Wyomissing PA 19610-2673
Phone: (610) 741-9776
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X
Behavioral Health & Social Service Providers / Clinical 103TC0700X PS008196L Pennsylvania

Profile Details

NPI number 1922106715
LBN Legal business name Tietbohl, Phillip J.
Credentials PH.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 20th, 2006
Last updated Feb 3rd, 2020 - about 6 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922106715 NPPES
Pennsylvania MEDICAID 001847159-0008
Pennsylvania MEDICAID 001847159-0006
Pennsylvania MEDICAID 001847159-0009
Pennsylvania MEDICAID 001847159-0012
Pennsylvania MEDICAID 001847159-0013
Pennsylvania MEDICAID 001847159-0007

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