Healthcare Provider Details

I. General information

NPI: 1497128623
Provider Name (Legal Business Name): GEORGE STEPHEN HYATT GATEWAY COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 HIGH ST STE 119
HAMILTON OH
45011-2709
US

IV. Provider business mailing address

1366 NEW LONDON RD
HAMILTON OH
45013-4010
US

V. Phone/Fax

Practice location:
  • Phone: 513-470-3691
  • Fax: 513-863-0378
Mailing address:
  • Phone: 513-470-3691
  • Fax: 513-863-0378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberI0700210
License Number StateOH

VIII. Authorized Official

Name: MR. GEORGE STEPHEN HYATT
Title or Position: LISW
Credential: LISW-S
Phone: 513-450-3691