Healthcare Provider Details

I. General information

NPI: 1720733553
Provider Name (Legal Business Name): KACEY MAY SPALLINGER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 02/21/2022
Certification Date: 02/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37303 HARVEST AVE
AVON OH
44011-2803
US

IV. Provider business mailing address

950 CAHOON RD
WESTLAKE OH
44145-1230
US

V. Phone/Fax

Practice location:
  • Phone: 440-847-8505
  • Fax: 440-866-6610
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2103299
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: