Provider Demographics
NPI:1447386693
Name:FENN, ROGER G (LPCC)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:G
Last Name:FENN
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 COLUMBUS AVE
Mailing Address - Street 2:STE 1-G
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-1682
Mailing Address - Country:US
Mailing Address - Phone:513-932-2386
Mailing Address - Fax:513-932-1333
Practice Address - Street 1:777 COLUMBUS AVE
Practice Address - Street 2:STE 1-G
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-1682
Practice Address - Country:US
Practice Address - Phone:513-932-2386
Practice Address - Fax:513-932-1333
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE 0002345101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health