Healthcare Provider Details

I. General information

NPI: 1275996001
Provider Name (Legal Business Name): KIMBERLY GARWOOD MAGES PHD, LPCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 ALBERT SABIN WAY
CINCINNATI OH
45229-2838
US

IV. Provider business mailing address

7254 STATEN RD
SARDINIA OH
45171-8709
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-5789
  • Fax: 513-558-3880
Mailing address:
  • Phone: 937-479-4803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.1100430-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: