MEDICARE: SHILOH FAMILY COUNSELING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1558917013
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHILOH FAMILY COUNSELING

Provider Business Mailing Address
First Line	:	2520 CALIFORNIA ST STE A
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-3677
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2520 CALIFORNIA ST STE A
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-3677
Country	:	US
Telephone Number	:	812-376-8562
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DEBRA GAYMAN
Credential	:	MSW, LCSW
Telephone Number	:	812-301-6573

Provider Enumeration Date	:	08/12/2019
Last Update Date	:	09/13/2019

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Directions to “SHILOH FAMILY COUNSELING ” Practice Location

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