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General NPI Number Information
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NPI Number | 1023767175
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Entity Type | Individual
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Provider Name | AUSTIN KLINGENSMITH
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Gender | Male
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Dates
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Enumeration Date | 03/23/2022
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Last Update Date | 10/19/2023
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Provider Practice Location Address
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Address Line | 165 E PARK AVE
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City | NILES
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State | OH
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Zip | 44446-2352
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Country | US
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Telephone | 330-544-8005
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Fax | 330-544-9379
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Provider Business Mailing Address
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Address Line | 4841 WESTCHESTER DR APT 302
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City | AUSTINTOWN
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State | OH
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Zip | 44515-2553
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Country | US
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Telephone | 330-599-6810
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C.2305553
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License Number State | OH
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