Provider Demographics
NPI:1518750074
Name:LOUGHMAN, TAI ALYSSA (CDCA)
Entity type:Individual
Prefix:
First Name:TAI
Middle Name:ALYSSA
Last Name:LOUGHMAN
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 SELLS RD APT G3
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3447
Mailing Address - Country:US
Mailing Address - Phone:740-607-9881
Mailing Address - Fax:
Practice Address - Street 1:4040 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1156
Practice Address - Country:US
Practice Address - Phone:614-705-2767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-27
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.192523101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)