Healthcare Provider Details

I. General information

NPI: 1871153924
Provider Name (Legal Business Name): KIMBERLY B CHASE-BRENNAN LPCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 W PARK DR
LORAIN OH
44053-1138
US

IV. Provider business mailing address

2115 W PARK DR
LORAIN OH
44053-1138
US

V. Phone/Fax

Practice location:
  • Phone: 440-989-4900
  • Fax: 440-282-4779
Mailing address:
  • Phone: 440-989-4900
  • Fax: 440-282-4779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0005949-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: