Provider Demographics
NPI:1053658203
Name:CLUSE-TOLAR, THERESA (LISW-S, PHD)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:CLUSE-TOLAR
Suffix:
Gender:F
Credentials:LISW-S, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 ARLINGTON AVE
Mailing Address - Street 2:MS 1161
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2595
Mailing Address - Country:US
Mailing Address - Phone:419-530-4397
Mailing Address - Fax:419-530-4141
Practice Address - Street 1:3000 ARLINGTON AVE
Practice Address - Street 2:MS 1161
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-2595
Practice Address - Country:US
Practice Address - Phone:419-530-4397
Practice Address - Fax:419-530-4141
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 00004585-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical