Healthcare Provider Details

I. General information

NPI: 1578651915
Provider Name (Legal Business Name): KATHLEEN RAE SABOL MSED, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN RAE TARTLER MSED, LPCC

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 JAVIT CT
AUSTINTOWN OH
44515-2409
US

IV. Provider business mailing address

6810 RUBY CTS
AUSTINTOWN OH
44515-5610
US

V. Phone/Fax

Practice location:
  • Phone: 330-797-4050
  • Fax: 330-797-4090
Mailing address:
  • Phone: 330-793-1372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE-0002683
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: