Individual
KENNETH STAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPCC-S, LICDC
Contact information
Practice address
4879 US HIGHWAY 68 S, WEST LIBERTY, OH 43357
(937) 599-1411
(937) 599-4128
Mailing address
4879 US HIGHWAY 68 S, WEST LIBERTY, OH 43357-9525
(937) 599-1411
(937) 599-4128
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LICDC.161786
OH
101YP2500X
Professional Counselor
Primary
E1700041-SUPV
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0213436
—
OH
Enumeration date
02/13/2017
Last updated
04/16/2019
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