Provider Demographics
NPI:1396807434
Name:EICHENAUER, KENT ALAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:ALAN
Last Name:EICHENAUER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 104
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-0104
Mailing Address - Country:US
Mailing Address - Phone:937-206-6500
Mailing Address - Fax:
Practice Address - Street 1:205 PALMER AVE
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311
Practice Address - Country:US
Practice Address - Phone:937-206-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4151103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH113445OtherMANAGED HEALTH NETWORK
OH3416952163A12OtherANTHEM
OH0783657Medicaid
OH3416952163A12OtherANTHEM