Provider Demographics
NPI:1639386071
Name:KETRING, BRENT (LPC-MHSP)
Entity type:Individual
Prefix:MR
First Name:BRENT
Middle Name:
Last Name:KETRING
Suffix:
Gender:M
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 HARRAH DR STE M
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-6255
Mailing Address - Country:US
Mailing Address - Phone:502-413-1949
Mailing Address - Fax:
Practice Address - Street 1:3011 HARRAH DR STE M
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-6255
Practice Address - Country:US
Practice Address - Phone:502-413-1949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2925101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional