MEDICARE: KYLE LINNEMANN L.P.C.C.

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	101Y00000X	Counselor	E.1400022	OH
2	101YM0800X	Mental Health Counselor	E.1400022	OH
3	101YP2500X	Professional Counselor	E.1400022	OH

General Provider Information

NPI Number	:	1164834115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE LINNEMANN L.P.C.C.

Provider Business Mailing Address
First Line	:	885 DOERIDGE DR
Second Line	:
City	:	ERLANGER
State	:	KY
Zip	:	41018-2995
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2117 BEECHMONT AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-5414
Country	:	US
Telephone Number	:	859-760-6743
Fax Number	:

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

Provider Enumeration Date	:	05/27/2014
Last Update Date	:	03/15/2016

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