MEDICARE: SKYE SALEH

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	12313	TX

General Provider Information

NPI Number	:	1811631500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SKYE SALEH

Provider Business Mailing Address
First Line	:	3111 RACE ST APT 1231
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76111-4140
Country	:	US
Telephone Number	:	817-841-9626
Fax Number	:

Provider Business Practice Location Address
First Line	:	3111 RACE ST APT 1231
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76111-4140
Country	:	US
Telephone Number	:	817-841-9626
Fax Number	:

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

Provider Enumeration Date	:	04/27/2022
Last Update Date	:	04/27/2022

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Directions to “ SKYE SALEH ” Practice Location

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