Healthcare Provider Details

I. General information

NPI: 1649717547
Provider Name (Legal Business Name): KARI LYNN HARRIS BS, LSW, LCDCIII
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARI LYNN KESTING

II. Dates (important events)

Enumeration Date: 01/30/2017
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 S DIXIE DR STE 260
DAYTON OH
45409-1542
US

IV. Provider business mailing address

10100 ELIDA RD
DELPHOS OH
45833-9056
US

V. Phone/Fax

Practice location:
  • Phone: 937-497-7239
  • Fax: 937-497-7238
Mailing address:
  • Phone: 419-695-8010
  • Fax: 419-695-5065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDCIII.162290
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2001654-TRNE
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2207530
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2405825
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: