MEDICARE: KENDALL HARVEY SR. CDCA,QMHS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	103TC1900X	Counseling Psychologist	OH
2	3245S0500X	Children's Substance Abuse Rehabilitation Facility	OH
3	171M00000X	Case Manager/Care Coordinator	OH

General Provider Information

NPI Number	:	1720501463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDALL HARVEY SR. CDCA,QMHS

Provider Business Mailing Address
First Line	:	1327 BELMONT AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43607-4108
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1327 BELMONT AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43607-4108
Country	:	US
Telephone Number	:	567-395-5711
Fax Number	:

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

Provider Enumeration Date	:	07/25/2017
Last Update Date	:	07/25/2017

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