Healthcare Provider Details

I. General information

NPI: 1649832544
Provider Name (Legal Business Name): SCHAYE GORDLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 E MAIN ST
WEST UNION OH
45693-1568
US

IV. Provider business mailing address

923 FINDLAY ST
PORTSMOUTH OH
45662-4148
US

V. Phone/Fax

Practice location:
  • Phone: 937-544-5218
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.16277
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberQMHS
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: