Provider Demographics
NPI:1972326478
Name:SIPLE, KEVIN MICHAEL
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:MICHAEL
Last Name:SIPLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5520 HARRISON AVE STE D
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-2363
Mailing Address - Country:US
Mailing Address - Phone:513-922-1660
Mailing Address - Fax:513-922-6230
Practice Address - Street 1:5520 HARRISON AVE STE D
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-2363
Practice Address - Country:US
Practice Address - Phone:513-922-1660
Practice Address - Fax:513-922-6230
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS31422101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional