Provider Demographics
NPI:1427012442
Name:ERVIN, KATHLEEN ELIZABETH (MED, LSW, LPCC-S)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ELIZABETH
Last Name:ERVIN
Suffix:
Gender:F
Credentials:MED, LSW, LPCC-S
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:ELIZABETH
Other - Last Name:GRIFFITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4194 W US HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-9663
Mailing Address - Country:US
Mailing Address - Phone:937-875-6795
Mailing Address - Fax:
Practice Address - Street 1:4194 W US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-9663
Practice Address - Country:US
Practice Address - Phone:937-875-6795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE 0600660.SUPV101YP2500X
OHS-0015843104100000X
OHE.0600660-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker