Healthcare Provider Details

I. General information

NPI: 1316858749
Provider Name (Legal Business Name): GYLLIEN RUBY NOELLE ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 W WATER ST
OAK HARBOR OH
43449-1332
US

IV. Provider business mailing address

216 S MERCER RD APT 1
BOWLING GREEN OH
43402-3360
US

V. Phone/Fax

Practice location:
  • Phone: 419-707-3033
  • Fax: 419-707-3033
Mailing address:
  • Phone: 330-945-0609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: