Provider Demographics
NPI:1225692270
Name:SYRUS, ANTHONY WAYNE
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:WAYNE
Last Name:SYRUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 COLONIAL DR APT 102
Mailing Address - Street 2:
Mailing Address - City:BIDWELL
Mailing Address - State:OH
Mailing Address - Zip Code:45614-9249
Mailing Address - Country:US
Mailing Address - Phone:740-709-2009
Mailing Address - Fax:
Practice Address - Street 1:499 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1398
Practice Address - Country:US
Practice Address - Phone:740-446-6471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH001229101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)