MEDICARE: SKYWAY COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1578375937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKYWAY COUNSELING LLC

Provider Business Mailing Address
First Line	:	3618 DAVENANT AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45213-2108
Country	:	US
Telephone Number	:	513-518-2102
Fax Number	:

Provider Business Practice Location Address
First Line	:	4847 EASTERN AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-4450
Country	:	US
Telephone Number	:	513-399-6843
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MADELYNNE CAMPBELL
Credential	:	LPC
Telephone Number	:	513-399-6843

Provider Enumeration Date	:	01/23/2025
Last Update Date	:	01/23/2025

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Directions to “SKYWAY COUNSELING LLC ” Practice Location

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