Provider Demographics
NPI:1538478375
Name:PRENDERGAST, KEVIN JAMES (LPCC-S)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:JAMES
Last Name:PRENDERGAST
Suffix:
Gender:M
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11121 KENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-1817
Mailing Address - Country:US
Mailing Address - Phone:513-977-2141
Mailing Address - Fax:513-487-4632
Practice Address - Street 1:11121 KENWOOD RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-1817
Practice Address - Country:US
Practice Address - Phone:513-977-2141
Practice Address - Fax:513-487-4632
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE 0003441101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional