Provider Demographics
NPI:1477997732
Name:KEAR, AMBER SHAVONNE (MFT)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:SHAVONNE
Last Name:KEAR
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 178
Mailing Address - Street 2:
Mailing Address - City:GROVEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43125-0178
Mailing Address - Country:US
Mailing Address - Phone:570-337-9731
Mailing Address - Fax:
Practice Address - Street 1:270 BRADENTON AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-7584
Practice Address - Country:US
Practice Address - Phone:614-263-8161
Practice Address - Fax:614-263-8268
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHM.1200010106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist