Healthcare Provider Details

I. General information

NPI: 1225416357
Provider Name (Legal Business Name): JACOB ANDREW BEUERLEIN LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2015
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 EZZARD CHARLES DR
CINCINNATI OH
45214-2525
US

IV. Provider business mailing address

830 EZZARD CHARLES DR
CINCINNATI OH
45214-2525
US

V. Phone/Fax

Practice location:
  • Phone: 513-381-6672
  • Fax: 513-381-6086
Mailing address:
  • Phone: 513-381-6672
  • Fax: 513-381-6086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.1400053
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.1700271
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: