Provider Demographics
NPI:1659762300
Name:PYLES, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:PYLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4172 INDIAN RIPPLE RD STE B
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45440-3286
Mailing Address - Country:US
Mailing Address - Phone:937-490-2090
Mailing Address - Fax:937-490-2780
Practice Address - Street 1:4172 INDIAN RIPPLE RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45440-3285
Practice Address - Country:US
Practice Address - Phone:937-490-2090
Practice Address - Fax:937-490-2780
Is Sole Proprietor?:No
Enumeration Date:2015-02-16
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC 1400578101Y00000X
OHE.1700084101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0220046Medicaid