Provider Demographics
NPI:1386530475
Name:JOSEPH, CODY (PEER SUPPORT)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:PEER SUPPORT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:OH
Mailing Address - Zip Code:45744-7616
Mailing Address - Country:US
Mailing Address - Phone:740-336-8391
Mailing Address - Fax:
Practice Address - Street 1:4977 NORTHCUTT PL
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-3839
Practice Address - Country:US
Practice Address - Phone:800-829-5461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH006479175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist