Healthcare Provider Details

I. General information

NPI: 1427012442
Provider Name (Legal Business Name): KATHLEEN ELIZABETH ERVIN M.ED., LSW, LPCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHLEEN ELIZABETH GRIFFITH

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4194 W US HIGHWAY 36
URBANA OH
43078-9663
US

IV. Provider business mailing address

4194 W US HIGHWAY 36
URBANA OH
43078-9663
US

V. Phone/Fax

Practice location:
  • Phone: 937-875-6795
  • Fax:
Mailing address:
  • Phone: 937-875-6795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.0600660-SUPV
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE 0600660.SUPV
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS-0015843
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: