Provider Demographics
NPI:1407300049
Name:KENNEDY HEIGHTS COUNSELING SERVICES
Entity Type:Organization
Organization Name:KENNEDY HEIGHTS COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:513-266-9581
Mailing Address - Street 1:3738 DAVENANT AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45213-2219
Mailing Address - Country:US
Mailing Address - Phone:513-266-9581
Mailing Address - Fax:
Practice Address - Street 1:3738 DAVENANT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45213-2219
Practice Address - Country:US
Practice Address - Phone:513-266-9581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1000112305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service