MEDICARE: MR. BRENT KETRING LPC-MHSP

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	2925	TN

General Provider Information

NPI Number	:	1639386071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRENT KETRING LPC-MHSP

Provider Business Mailing Address
First Line	:	3011 HARRAH DR STE M
Second Line	:
City	:	SPRING HILL
State	:	TN
Zip	:	37174-6255
Country	:	US
Telephone Number	:	502-413-1949
Fax Number	:

Provider Business Practice Location Address
First Line	:	3011 HARRAH DR STE M
Second Line	:
City	:	SPRING HILL
State	:	TN
Zip	:	37174-6255
Country	:	US
Telephone Number	:	502-413-1949
Fax Number	:

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

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	02/20/2014

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