Provider Demographics
NPI:1245371178
Name:ERNSTING, KENT DOUGLAS (PCC, LSW)
Entity type:Individual
Prefix:MR
First Name:KENT
Middle Name:DOUGLAS
Last Name:ERNSTING
Suffix:
Gender:M
Credentials:PCC, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 GATEWAY BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-1895
Mailing Address - Country:US
Mailing Address - Phone:513-779-7400
Mailing Address - Fax:513-779-7426
Practice Address - Street 1:5750 GATEWAY
Practice Address - Street 2:SUITE 103
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-1894
Practice Address - Country:US
Practice Address - Phone:513-779-7400
Practice Address - Fax:513-779-7426
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE3261101YP2500X
OHS17449104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker