Healthcare Provider Details

I. General information

NPI: 1457065492
Provider Name (Legal Business Name): DAVID EDWARD SALAS M.A., M.B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2023
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 NOTRE DAME AVE
DAYTON OH
45404-1925
US

IV. Provider business mailing address

143 NOTRE DAME AVE
DAYTON OH
45404-1925
US

V. Phone/Fax

Practice location:
  • Phone: 505-652-8082
  • Fax:
Mailing address:
  • Phone: 505-652-8082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2022-0962
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: