Healthcare Provider Details

I. General information

NPI: 1184118630
Provider Name (Legal Business Name): KATHLEEN BYRNES CRC, LPC, CCM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3264 LONGSPUR DR
COLUMBUS OH
43228-9155
US

IV. Provider business mailing address

3264 LONGSPUR DR
COLUMBUS OH
43228-9155
US

V. Phone/Fax

Practice location:
  • Phone: 740-963-0323
  • Fax:
Mailing address:
  • Phone: 740-963-0323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC0900452
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number00113141
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number4232595
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: