Provider Demographics
NPI:1568785236
Name:KERSHNER, KYLE (PCC-S NCC LICDC-CS)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:
Last Name:KERSHNER
Suffix:
Gender:M
Credentials:PCC-S NCC LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 A SOUTH MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-3509
Mailing Address - Country:US
Mailing Address - Phone:740-393-6001
Mailing Address - Fax:740-393-6040
Practice Address - Street 1:111 A SOUTH MULBERRY ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050
Practice Address - Country:US
Practice Address - Phone:740-393-6001
Practice Address - Fax:740-393-6040
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH081270101YA0400X
OHE 0500681101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)