1497128623 NPI number — GEORGE STEPHEN HYATT GATEWAY COUNSELING, LLC

Table of content: (NPI 1497128623)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497128623 NPI number — GEORGE STEPHEN HYATT GATEWAY COUNSELING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGE STEPHEN HYATT GATEWAY COUNSELING, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497128623
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1366 NEW LONDON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMILTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45013-4010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-470-3691
Provider Business Mailing Address Fax Number:
513-863-0378

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 HIGH ST
Provider Second Line Business Practice Location Address:
STE 119
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45011-2709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-470-3691
Provider Business Practice Location Address Fax Number:
513-863-0378
Provider Enumeration Date:
11/10/2015

Additional Information

Authorized Official

Authorized Official Last Name:
HYATT
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
STEPHEN
Authorized Official Title or Position:
LISW
Authorized Official Telephone Number:
513-450-3691

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X , with the licence number:  I0700210 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com