Healthcare Provider Details

I. General information

NPI: 1508712183
Provider Name (Legal Business Name): SUZY TRESOR TCHEGNELENE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6704 FOUNTAINS BLVD APT 201
WEST CHESTER OH
45069-2161
US

IV. Provider business mailing address

6704 FOUNTAINS BLVD APT 201
WEST CHESTER OH
45069-2161
US

V. Phone/Fax

Practice location:
  • Phone: 304-975-0260
  • Fax:
Mailing address:
  • Phone: 304-975-0260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCAPRE.195394
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: