Healthcare Provider Details

I. General information

NPI: 1881096766
Provider Name (Legal Business Name): KELLY E WARKENTIN MHA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8402 BLACKJACK RD
MOUNT VERNON OH
43050-9193
US

IV. Provider business mailing address

8402 BLACKJACK RD
MOUNT VERNON OH
43050-9193
US

V. Phone/Fax

Practice location:
  • Phone: 479-981-2543
  • Fax:
Mailing address:
  • Phone: 479-981-2543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.2608552
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: