Healthcare Provider Details

I. General information

NPI: 1689126823
Provider Name (Legal Business Name): CHRISTOPHER NEYLON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2016
Last Update Date: 01/26/2025
Certification Date: 01/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4840 HALEY RIDGE CT
CUMMING GA
30028-8966
US

IV. Provider business mailing address

4840 HALEY RIDGE CT
CUMMING GA
30028-8966
US

V. Phone/Fax

Practice location:
  • Phone: 708-207-4518
  • Fax:
Mailing address:
  • Phone: 708-207-4518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC014484
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: