Healthcare Provider Details

I. General information

NPI: 1407991862
Provider Name (Legal Business Name): DENE S BERMAN LIFESPAN COUNSELING ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1195 MEADOW BRIDGE DR STE B
BEAVERCREEK OH
45434-4302
US

IV. Provider business mailing address

PO BOX 340398
BEAVERCREEK OH
45434-0398
US

V. Phone/Fax

Practice location:
  • Phone: 937-426-2079
  • Fax: 937-426-0211
Mailing address:
  • Phone: 937-426-2079
  • Fax: 937-426-0211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SHARI BOONE
Title or Position: OFFICE MANAGER
Credential:
Phone: 937-426-2079