Healthcare Provider Details

I. General information

NPI: 1689264939
Provider Name (Legal Business Name): KATELYN JESSMER LMHC, CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 W MAIN ST
WATERTOWN NY
13601-1335
US

IV. Provider business mailing address

66 W BABCOCK ST
GOUVERNEUR NY
13642-1006
US

V. Phone/Fax

Practice location:
  • Phone: 315-788-1530
  • Fax:
Mailing address:
  • Phone: 315-286-7680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number009535
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number009535
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: