Healthcare Provider Details

I. General information

NPI: 1538832571
Provider Name (Legal Business Name): ERICH G SPENCE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 ELSINORE PL STE 500
CINCINNATI OH
45202-1455
US

IV. Provider business mailing address

300 WINDRIDGE LN APT 310
FLORENCE KY
41042-6651
US

V. Phone/Fax

Practice location:
  • Phone: 859-307-6141
  • Fax:
Mailing address:
  • Phone: 859-307-6141
  • Fax: 859-307-6141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number1538832571
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberC.2203861-TRNE
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1538832571
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: