Provider Demographics
NPI:1417273400
Name:PODRATZ, KIMBERLY A (LPCC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:PODRATZ
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 CENTER STREET
Mailing Address - Street 2:SUITE 218
Mailing Address - City:MIAMIVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45147-0218
Mailing Address - Country:US
Mailing Address - Phone:513-722-5694
Mailing Address - Fax:
Practice Address - Street 1:352 CENTER STREET
Practice Address - Street 2:SUITE 218
Practice Address - City:MIAMIVILLE
Practice Address - State:OH
Practice Address - Zip Code:45147-0218
Practice Address - Country:US
Practice Address - Phone:513-722-5694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE. 0700354101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH13555758OtherCAQH
OH0205690Medicaid
OH813780626OtherTAX ID