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General NPI Number Information
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NPI Number | 1306498134
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Entity Type | Individual
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Provider Name | ETHAN G PRESTON LCDC III, QMHS
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Gender | Male
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Dates
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Enumeration Date | 07/11/2019
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 700 PARK AVE
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City | IRONTON
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State | OH
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Zip | 45638-1502
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Country | US
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Telephone | 740-532-1613
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 108
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City | IRONTON
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State | OH
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Zip | 45638-0108
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Country | US
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Telephone |
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | CDCA.175127
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCDCIII.162777
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License Number State | OH
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