=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790461515
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHAYLA TUMBLESON CDCA, PRS, QBHS, CM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2023
-----------------------------------------------------
Last Update Date | 12/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14297 OHIO HIGHWAY 41
-----------------------------------------------------
City | WEST UNION
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45693
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-795-5020
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 304 E NORTH ST
-----------------------------------------------------
City | WEST UNION
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45693-1071
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-798-3967
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | CDCA.190636
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 175T00000X
-----------------------------------------------------
Taxonomy Name | Peer Specialist
-----------------------------------------------------
License Number | APS.003747
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------