Kane Carlock, LMHCA

Primary specialty

PsychologistTaxonomy code 103T00000X

License

P.08784 Issued in OH

Practice address

631 E State St
Georgetown, OH 45121-1437

Phone

(937) 378-6387

Fax

(937) 378-4253

NPI assigned

Mar 16, 2023

Last updated

Aug 31, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Healthsource of Ohio IncGroup PAC ID 2264328749, 56 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kane.carlock.p1@direct.hsohio.nextgenshare.com
• Direct secure messaging: kane.carlock.p3@direct.hpc.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Healthsource of Ohio, Inc.

  dba HealthSource: Anderson OB/Gyn

  • Obstetrics & Gynecology Physician
  • Cincinnati, OH
  • NPI 1275966863
  Medicare reassignment Care Compare group
• Healthsource of Ohio, Inc.

  dba HealthSource Blanchester

  • Clinic/Center
  • Blanchester, OH
  • NPI 1528826351
  NPD
• Healthsource of Ohio, Inc.

  dba HealthSource Georgetown Pediatrics and Family Practice

  • Primary Care Clinic/Center
  • Georgetown, OH
  • NPI 1700980869
  NPD
• Healthsource of Ohio, Inc.

  dba HealthSource: Georgetown Pediatrics and Family Practice

  • Federally Qualified Health Center (FQHC)
  • Georgetown, OH
  • NPI 1255372207
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1678924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788134400000",
    "number": "1558062430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "424 WARDS CORNER RD STE 200",
            "city": "LOVELAND",
            "state": "OH",
            "postal_code": "451406966",
            "telephone_number": "513-576-7700",
            "fax_number": "513-576-1020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "631 E STATE ST",
            "city": "GEORGETOWN",
            "state": "OH",
            "postal_code": "451211437",
            "telephone_number": "937-378-6387",
            "fax_number": "937-378-4253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLOCK",
        "first_name": "KANE",
        "credential": "LMHCA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-16",
        "last_updated": "2026-08-31",
        "certification_date": "2026-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OH",
            "license": "P.08784",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0125363",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley M Bryant
• Catherine Bundy
• Darren Ray Burns, LCDC III
• Jagena Ann Burns, RN
• Ray Leon Butt Jr.
• Tera Michele Carlson, LPN
• Devon Renee Carrington, LPN
• Tina M Cash, LSW
• Donna L Cavagnetto, LCDC III
• Etta Louise Charlebois, LISW-S

• Psychologist in Georgetown, OH
• Providers in Georgetown, OH by specialty
• Psychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.