Healthcare Provider Details

I. General information

NPI: 1427205780
Provider Name (Legal Business Name): MARY E KINSELLA LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4968 GLENWAY AVE
CINCINNATI OH
45238-3902
US

IV. Provider business mailing address

2600 VICTORY PKWY
CINCINNATI OH
45206-1711
US

V. Phone/Fax

Practice location:
  • Phone: 513-541-7577
  • Fax: 513-872-5182
Mailing address:
  • Phone: 513-872-5863
  • Fax: 513-872-5182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE0001443
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: