| Tyler Matthew Peckham, | |
|
3359 Kemp Rd Ste 200, Beavercreek, OH 45431-2567 | |
| (937) 490-2090 | |
| (937) 490-2780 |
| Full Name | Tyler Matthew Peckham |
|---|---|
| Gender | Male |
| Speciality | Mental Health Counselor |
| Experience | 3 Years |
| Location | 3359 Kemp Rd Ste 200, Beavercreek, Ohio |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013423367 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | E.2505064 (Ohio) | Primary |
| 171M00000X | Case Manager/care Coordinator | (* (Not Available)) | Secondary |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Samaritan Behavioral Health, Inc. | 0244148625 | 26 |
| Kettering Independent Medical Group Inc | 3173710936 | 602 |
| Entity Name | Samaritan Behavioral Health, Inc. |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1205888641 PECOS PAC ID: 0244148625 Enrollment ID: O20101007000860 |
| Mailing Address | Practice Location Address |
|---|---|
| Tyler Matthew Peckham, 303 W Ross St, Troy, OH 45373-3931 Ph: (937) 216-9282 | Tyler Matthew Peckham, 3359 Kemp Rd Ste 200, Beavercreek, OH 45431-2567 Ph: (937) 490-2090 |
David J Tieman, LPCC Counselor Medicare: Not Enrolled in Medicare Practice Location: 1321 Research Park Dr, Beavercreek, OH 45432 Phone: 937-427-3837 Fax: 937-427-4516 | |
Mrs. Deborah Kaye Baldwin, MS LPCC Counselor Medicare: Not Enrolled in Medicare Practice Location: 3351 Dayton Xenia Rd, Suite D, Beavercreek, OH 45432 Phone: 937-431-5035 Fax: 937-320-0824 | |
Lynn Oliver, Counselor Medicare: Medicare Enrolled Practice Location: 1321 Research Park Dr, Beavercreek, OH 45432 Phone: 937-437-3837 | |
Chester R Raleigh, LICDC Counselor Medicare: Not Enrolled in Medicare Practice Location: 3183 Beaver Vu Dr Ste C, Beavercreek, OH 45434 Phone: 937-431-8014 Fax: 937-431-8042 | |
John Hartman, Counselor Medicare: Medicare Enrolled Practice Location: 2145 N Fairfield Rd Ste 100, Beavercreek, OH 45431 Phone: 937-558-3900 Fax: 937-558-3999 | |
Nicklas Wright, Counselor Medicare: Not Enrolled in Medicare Practice Location: 3171 Beaver Vu Dr Ste C, Beavercreek, OH 45434 Phone: 937-306-8077 |