MEDICARE: KARA CANTU LPCC,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	011388	OH
2	101YM0800X	Mental Health Counselor	E0500942	OH

General Provider Information

NPI Number	:	1811439383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARA CANTU LPCC,LICDC

Provider Business Mailing Address
First Line	:	4135 DEMOREST RD
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-8646
Country	:	US
Telephone Number	:	614-551-8160
Fax Number	:

Provider Business Practice Location Address
First Line	:	4135 DEMOREST RD
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-8646
Country	:	US
Telephone Number	:	614-551-8160
Fax Number	:

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

Provider Enumeration Date	:	11/15/2016
Last Update Date	:	11/15/2016

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Directions to “ KARA CANTU LPCC,LICDC” Practice Location

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