MEDICARE: SHAYLA TUMBLESON CDCA, PRS, QBHS, CM

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCA.190636	OH
2	175T00000X	Peer Specialist	APS.003747	OH

General Provider Information

NPI Number	:	1790461515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAYLA TUMBLESON CDCA, PRS, QBHS, CM

Provider Business Mailing Address
First Line	:	304 E NORTH ST
Second Line	:
City	:	WEST UNION
State	:	OH
Zip	:	45693-1071
Country	:	US
Telephone Number	:	937-798-3967
Fax Number	:

Provider Business Practice Location Address
First Line	:	14297 OHIO HIGHWAY 41
Second Line	:
City	:	WEST UNION
State	:	OH
Zip	:	45693
Country	:	US
Telephone Number	:	937-795-5020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2023
Last Update Date	:	12/10/2025

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