Provider Demographics
NPI:1811439383
Name:CANTU, KARA (LPCC,LICDC)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:CANTU
Suffix:
Gender:F
Credentials:LPCC,LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4135 DEMOREST RD
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-8646
Mailing Address - Country:US
Mailing Address - Phone:614-551-8160
Mailing Address - Fax:
Practice Address - Street 1:4135 DEMOREST RD
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-8646
Practice Address - Country:US
Practice Address - Phone:614-551-8160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH011388101YA0400X
OHE0500942101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)