Provider Demographics
NPI:1063810596
Name:LENCL, MAXIMILLION M (LPCC)
Entity type:Individual
Prefix:
First Name:MAXIMILLION
Middle Name:M
Last Name:LENCL
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6797 N HIGH ST
Mailing Address - Street 2:SUITE 244
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2533
Mailing Address - Country:US
Mailing Address - Phone:614-505-7561
Mailing Address - Fax:614-505-7562
Practice Address - Street 1:6797 N HIGH ST
Practice Address - Street 2:SUITE 244
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2533
Practice Address - Country:US
Practice Address - Phone:614-505-7561
Practice Address - Fax:614-505-7562
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC1000113101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional