Provider Demographics
NPI:1497461867
Name:ENTENMAN, KYLE (LPC)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:
Last Name:ENTENMAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10422 KRAMER RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-9507
Mailing Address - Country:US
Mailing Address - Phone:419-410-5951
Mailing Address - Fax:
Practice Address - Street 1:10422 KRAMER RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-9507
Practice Address - Country:US
Practice Address - Phone:419-410-5951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1801503101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health