Healthcare Provider Details

I. General information

NPI: 1134840499
Provider Name (Legal Business Name): KELLY GROVER COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4450 CARVER WOODS DR STE 2
BLUE ASH OH
45242-5528
US

IV. Provider business mailing address

4450 CARVER WOODS DR STE 2
BLUE ASH OH
45242-5528
US

V. Phone/Fax

Practice location:
  • Phone: 513-984-9940
  • Fax: 513-984-9858
Mailing address:
  • Phone: 513-984-9940
  • Fax: 513-984-9858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KELLY J GROVER
Title or Position: MEMBER
Credential: LISW-S
Phone: 419-377-6316