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General NPI Number Information
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NPI Number | 1316652894
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Entity Type | Organization
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Legal Business Name | J. KILBY ENTERPRISES, INC.
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Dates
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Enumeration Date | 01/18/2023
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Last Update Date | 01/18/2023
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Provider Practice Location Address
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Address Line | 955 CONGRESS PARK DR
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City | CENTERVILLE
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State | OH
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Zip | 45459-4009
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Country | US
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Telephone | 937-320-1020
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Fax |
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Provider Business Mailing Address
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Address Line | 4273 BRISTOL DR
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City | BEAVERCREEK
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State | OH
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Zip | 45440-3382
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Country | US
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Telephone | 937-689-6450
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAMES GILBERT KILBY JR.
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Credential |
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Telephone | 937-689-6450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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