Healthcare Provider Details

I. General information

NPI: 1659762300
Provider Name (Legal Business Name): EMILY PYLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2015
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4172 INDIAN RIPPLE RD
BEAVERCREEK OH
45440-3285
US

IV. Provider business mailing address

4172 INDIAN RIPPLE RD STE B
BEAVERCREEK OH
45440-3286
US

V. Phone/Fax

Practice location:
  • Phone: 937-490-2090
  • Fax: 937-490-2780
Mailing address:
  • Phone: 937-490-2090
  • Fax: 937-490-2780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC 1400578
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.1700084
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: