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General NPI Number Information
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NPI Number | 1285173179
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Entity Type | Individual
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Provider Name | KENNETH STAHL LPCC-S, LICDC
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Gender | Male
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Dates
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Enumeration Date | 02/13/2017
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Last Update Date | 04/16/2019
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Provider Practice Location Address
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Address Line | 4879 US HIGHWAY 68 S
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City | WEST LIBERTY
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State | OH
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Zip | 43357
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Country | US
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Telephone | 937-599-1411
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Fax | 937-599-4128
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Provider Business Mailing Address
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Address Line | 4879 US HIGHWAY 68 S
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City | WEST LIBERTY
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State | OH
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Zip | 43357-9525
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Country | US
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Telephone | 937-599-1411
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Fax | 937-599-4128
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LICDC.161786
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E1700041-SUPV
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License Number State | OH
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