MEDICARE: J. ERIC GENTILE MS, LPCC

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	101YP2500X	Professional Counselor	E1100307	OH

General Provider Information

NPI Number	:	1598039513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	J. ERIC GENTILE MS, LPCC

Provider Business Mailing Address
First Line	:	PO BOX 20745
Second Line	:
City	:	UPPER ARLINGTON
State	:	OH
Zip	:	43220-0745
Country	:	US
Telephone Number	:	614-940-9834
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 BETHEL RD STE 201
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-2071
Country	:	US
Telephone Number	:	614-940-9834
Fax Number	:

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

Provider Enumeration Date	:	03/08/2012
Last Update Date	:	03/20/2023

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