=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457991952
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMEENA KEMAVOR LPCC-S
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2020
-----------------------------------------------------
Last Update Date | 12/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 168 BANNOCKBURN BLVD
-----------------------------------------------------
City | BLACKLICK
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43004-9786
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-849-2389
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1900 BRICE RD STE B
-----------------------------------------------------
City | REYNOLDSBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43068-3403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-239-9965
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | E.0500614
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | E.0500614
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------