Provider Demographics
NPI:1497128623
Name:GEORGE STEPHEN HYATT GATEWAY COUNSELING, LLC
Entity Type:Organization
Organization Name:GEORGE STEPHEN HYATT GATEWAY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LISW
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:HYATT
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:513-450-3691
Mailing Address - Street 1:1366 NEW LONDON RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-4010
Mailing Address - Country:US
Mailing Address - Phone:513-470-3691
Mailing Address - Fax:513-863-0378
Practice Address - Street 1:20 HIGH ST
Practice Address - Street 2:STE 119
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-2709
Practice Address - Country:US
Practice Address - Phone:513-470-3691
Practice Address - Fax:513-863-0378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0700210261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health