| J. Kilby Enterprises, Inc. | |
|
955 Congress Park Dr Centerville OH 45459-4009 | |
| (937) 320-1020 | |
| Not Available |
| Full Name | J. Kilby Enterprises, Inc. |
|---|---|
| Speciality | Counselor |
| Location | 955 Congress Park Dr, Centerville, Ohio |
| Authorized Official Name and Position | James Gilbert Kilby (OWNER) |
| Authorized Official Contact | 9376896450 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| J. Kilby Enterprises, Inc. 4273 Bristol Dr Beavercreek OH 45440-3382 Ph: (937) 689-6450 | J. Kilby Enterprises, Inc. 955 Congress Park Dr Centerville OH 45459-4009 Ph: (937) 320-1020 |
| NPI Number | 1316652894 |
|---|---|
| Provider Enumeration Date | 01/18/2023 |
| Last Update Date | 01/18/2023 |
| Certification Date | 01/18/2023 |
| Medicare PECOS PAC ID | 7214302223 |
|---|---|
| Medicare Enrollment ID | O20230405000678 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316652894 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Denetta V Harris |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295024750 PECOS PAC ID: 6507236874 Enrollment ID: I20221230002172 |
| Provider Name | Gary Thomas Ratliff |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063951556 PECOS PAC ID: 5395110316 Enrollment ID: I20230405000748 |
| Provider Name | Julian A Travis |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1306355953 PECOS PAC ID: 8729430129 Enrollment ID: I20240122003278 |
| Provider Name | Melodie K Morrow |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285131904 PECOS PAC ID: 4183076599 Enrollment ID: I20240122003690 |
| Provider Name | Lynn R Harris |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1659507366 PECOS PAC ID: 2769632496 Enrollment ID: I20240122004150 |
| Provider Name | Tandy L Cyrus |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1821337122 PECOS PAC ID: 1456793322 Enrollment ID: I20240523000473 |
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