Healthcare Provider Details

I. General information

NPI: 1639444847
Provider Name (Legal Business Name): STEPHANIE A. KONESKY LPCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3659 GREEN RD STE 102
BEACHWOOD OH
44122-5715
US

IV. Provider business mailing address

3659 GREEN RD STE 102
BEACHWOOD OH
44122-5715
US

V. Phone/Fax

Practice location:
  • Phone: 440-749-1326
  • Fax:
Mailing address:
  • Phone: 440-749-1326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.1000581-SUPV
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.1000581
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: