Provider Demographics
NPI:1447552906
Name:KREITZER, GARRICK T (LPCC)
Entity type:Individual
Prefix:
First Name:GARRICK
Middle Name:T
Last Name:KREITZER
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9685 CAPRI CT
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:KY
Mailing Address - Zip Code:41091-7617
Mailing Address - Country:US
Mailing Address - Phone:859-512-8627
Mailing Address - Fax:
Practice Address - Street 1:9685 CAPRI CT
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:KY
Practice Address - Zip Code:41091-7617
Practice Address - Country:US
Practice Address - Phone:859-512-8627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-03
Last Update Date:2024-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY291112101YP2500X
KY0808101YP2500X
OH0701184101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional