Provider Demographics
NPI:1184118630
Name:BYRNES, KATHLEEN (CRC, LPC, CCM)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:BYRNES
Suffix:
Gender:F
Credentials:CRC, LPC, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3264 LONGSPUR DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-9155
Mailing Address - Country:US
Mailing Address - Phone:740-963-0323
Mailing Address - Fax:
Practice Address - Street 1:3264 LONGSPUR DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-9155
Practice Address - Country:US
Practice Address - Phone:740-963-0323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4232595171M00000X
OH00113141225C00000X
OHC0900452101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor