Provider Demographics
NPI:1528576048
Name:CLONTZ, ERIC (MA, LPCC)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:CLONTZ
Suffix:
Gender:M
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 PARK MEADOW RD STE H
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-2876
Mailing Address - Country:US
Mailing Address - Phone:614-948-3273
Mailing Address - Fax:855-740-2025
Practice Address - Street 1:635 PARK MEADOW RD STE 107
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2877
Practice Address - Country:US
Practice Address - Phone:614-948-3273
Practice Address - Fax:855-740-2025
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2303700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional