Individual
CODY SHY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CDCA, PRS
Contact information
Practice address
9620 CAREYS RUN POND CREEK ROAD, MCDERMOTT, OH 45652
(740) 858-6683
Mailing address
PO BOX 402, WHEELERSBURG, OH 45694-0402
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA.175939
OH
101YM0800X
Mental Health Counselor
—
OH
175T00000X
Peer Specialist
APS.004898
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000733
—
OH
Enumeration date
08/02/2022
Last updated
07/23/2024
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