Provider Demographics
NPI:1699913517
Name:ROGER FENN LPCC AND ASSOCIATES LLC
Entity type:Organization
Organization Name:ROGER FENN LPCC AND ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:G
Authorized Official - Last Name:FENN
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:513-932-2386
Mailing Address - Street 1:777 COLUMBUS AVE
Mailing Address - Street 2:STE 1-G
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-1682
Mailing Address - Country:US
Mailing Address - Phone:513-932-2386
Mailing Address - Fax:513-932-2386
Practice Address - Street 1:777 COLUMBUS AVE
Practice Address - Street 2:STE 1-G
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-1682
Practice Address - Country:US
Practice Address - Phone:513-932-2386
Practice Address - Fax:513-932-2386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty