Healthcare Provider Details

I. General information

NPI: 1679083059
Provider Name (Legal Business Name): KATELYN MARIE STEVENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATELYN MARIE WILLIAMS

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 C COURT
ASHTABULA OH
44004-4577
US

IV. Provider business mailing address

2801 C COURT
ASHTABULA OH
44004-4577
US

V. Phone/Fax

Practice location:
  • Phone: 440-998-4210
  • Fax: 440-998-6489
Mailing address:
  • Phone: 440-998-4210
  • Fax: 440-998-6489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2303737
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: