Kyle Kershner, PCC-S NCC LICDC-CS

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

E 0500681 Issued in OH

Practice address

111 A South Mulberry St
Mount Vernon, OH 43050

Phone

(740) 393-6001

Fax

(740) 393-6040

NPI assigned

Mar 9, 2010

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Sojourners Counseling Services

  • Counselor
  • Mount Vernon, OH
  • NPI 1720334949

  Addiction (Substance Use Disorder)

  NPD (past) Authorized official

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

{
    "created_epoch": "1268092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398816000000",
    "number": "1568785236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 A SOUTH MULBERRY ST",
            "city": "MOUNT VERNON",
            "state": "OH",
            "postal_code": "430503509",
            "telephone_number": "740-393-6001",
            "fax_number": "740-393-6040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 A SOUTH MULBERRY ST",
            "city": "MOUNT VERNON",
            "state": "OH",
            "postal_code": "43050",
            "telephone_number": "740-393-6001",
            "fax_number": "740-393-6040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERSHNER",
        "first_name": "KYLE",
        "name_prefix": "Mr.",
        "credential": "PCC-S NCC LICDC-CS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-03-09",
        "last_updated": "2014-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "081270",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "E 0500681",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carrie L Keller
• Catriona Galloway Keller, PH.D.
• Makenzie Wronkovich Keller, MA, CCC-SLP
• Matthew Kelling, DPT
• Timothy Joseph Kennedy
• Crystal M Kidd
• Karrie A Kidd
• Kevin Kristopher Kidwell
• Lisa Kiener, CDCA
• Mary Ann Kilkenny, R.N.

• Professional Counselor in Mount Vernon, OH
• Providers in Mount Vernon, OH by specialty
• Professional Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.