Devynne Taylor-Faye Eldridge
Individual provider Active NPI Counselor · Piketon, OH
NPI 1376329698 · NPPES record last updated Apr 15, 2025
Key facts
- NPI
- 1376329698
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- License
- C2506890 (OH)
- Practice address
- 316 E Main St
Piketon, OH 45661-8018 - Phone
- (740) 395-1383
- NPI assigned
- Sep 1, 2023
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C2506890 | OH | MD | Counselor |
| C.2405559-TRNE | OH | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Phoenix Group Home, LLC | Current |
Accepting new patients | |
| Phoenix Group Home, LLC | Past |
Accepting new patients |
Locations
306 W Union St
Athens, OH 45701
Phone (740) 764-4529
Interoperability endpoints
- https://api.qualifacts.org/api/fhir/pathihc/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | |||
| Mental Health Counselor | 101YM0800X | C.2405559-TRNE | OH | |
| Counselor | 101Y00000X | C2506890 | OH | Yes |
Addresses
Primary practice location
316 E Main St
Piketon, OH 45661-8018
Mailing address
176 Simpson Rd
Jackson, OH 45640-9498
Phone (740) 395-1383
Other providers in Piketon, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 15, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.