Provider Demographics
NPI:1952899817
Name:ACHTERMANN, KYA (LCDCIII)
Entity Type:Individual
Prefix:
First Name:KYA
Middle Name:
Last Name:ACHTERMANN
Suffix:
Gender:F
Credentials:LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 ROSSGATE CT
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-9558
Mailing Address - Country:US
Mailing Address - Phone:513-738-7600
Mailing Address - Fax:513-738-7601
Practice Address - Street 1:3621 ROSSGATE CT
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-9558
Practice Address - Country:US
Practice Address - Phone:513-738-7600
Practice Address - Fax:513-738-7601
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCIII.161629101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)