Healthcare Provider Details

I. General information

NPI: 1205971702
Provider Name (Legal Business Name): JEWELL L GIEDROYCE LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 EDWIN C MOSES BLVD, 1ST FLOOR SAMARITAN BEHAVIORAL HEALTH, INC.
DAYTON OH
45417-3424
US

IV. Provider business mailing address

601 EDWIN C. MOSES BLVD. 1ST FLOOR SAMARITAN BEHAVIORAL HEALTH, INC.
DAYTON OH
45417-3424
US

V. Phone/Fax

Practice location:
  • Phone: 937-734-8333
  • Fax: 937-734-4343
Mailing address:
  • Phone: 937-734-8333
  • Fax: 937-734-4343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.0008260
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: