Doctor Name: | JACK BRIAN KERN |
NPI Number: | 1033370424 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MED, PC |
License Number: | C 0602132 |
Business Practice Address: | 8445 Munson Rd Mentor, OH - 440602410 |
Business Phone Number: | 4402551700 |
Business Fax Number: | 4402052417 |
Mailing Address: | 8445 Munson Rd, MENTOR |
State: | OH |
Postal Code: | 440602410 |
Phone Number: | 4402551700 |
Fax Number: | 4402052417 |
NPI Enumeration Date: | 06/19/2008 |
NPI Last Update Date: | 06/19/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | C 0602132 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |