Provider Demographics
NPI:1295195881
Name:CHAMPION, MACHEN (LPCC-S, RPT-S)
Entity Type:Individual
Prefix:
First Name:MACHEN
Middle Name:
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:LPCC-S, RPT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 HILLTOP LN
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:OH
Mailing Address - Zip Code:45215-4124
Mailing Address - Country:US
Mailing Address - Phone:513-679-1571
Mailing Address - Fax:
Practice Address - Street 1:1327 E KEMPER RD STE 3100A
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3945
Practice Address - Country:US
Practice Address - Phone:513-935-1993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1901239-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health