Provider Demographics
NPI:1467723031
Name:GLENN A FELTZ & KENT A EICHENAUER PTRS
Entity Type:Organization
Organization Name:GLENN A FELTZ & KENT A EICHENAUER PTRS
Other - Org Name:DELTA PSYCHOLOGY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:A
Authorized Official - Last Name:EICHENAUER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:937-652-1474
Mailing Address - Street 1:43 WEST MCCREIGHT AVENUE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-1813
Mailing Address - Country:US
Mailing Address - Phone:937-325-2273
Mailing Address - Fax:937-652-4700
Practice Address - Street 1:430 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-2402
Practice Address - Country:US
Practice Address - Phone:937-652-1474
Practice Address - Fax:937-652-4700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9255812Medicare UPIN