MEDICARE: MARY E KINSELLA LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	E0001443	OH

General Provider Information

NPI Number	:	1427205780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY E KINSELLA LPCC

Provider Business Mailing Address
First Line	:	2600 VICTORY PKWY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-1711
Country	:	US
Telephone Number	:	513-872-5863
Fax Number	:	513-872-5182

Provider Business Practice Location Address
First Line	:	4968 GLENWAY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-3902
Country	:	US
Telephone Number	:	513-541-7577
Fax Number	:	513-872-5182

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2008
Last Update Date	:	08/19/2008

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