MEDICARE: MR. JOHN EDWARD ENTINGH SR. LSW, LICDC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	141191	OH
2	1041C0700X	Clinical Social Worker	S.1501042	OH

General Provider Information

NPI Number	:	1093267486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN EDWARD ENTINGH SR. LSW, LICDC

Provider Business Mailing Address
First Line	:	PO BOX 243
Second Line	:
City	:	SUGAR GROVE
State	:	OH
Zip	:	43155-0243
Country	:	US
Telephone Number	:	614-404-6008
Fax Number	:

Provider Business Practice Location Address
First Line	:	551 1/2 E MAIN ST
Second Line	:
City	:	LANCASTER
State	:	OH
Zip	:	43130-3809
Country	:	US
Telephone Number	:	614-404-6008
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2016
Last Update Date	:	07/21/2022

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