Healthcare Provider Details

I. General information

NPI: 1235669201
Provider Name (Legal Business Name): TAYLOR KRISTINE OPFER MA, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAYLOR KRISTINE STOLL

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 CENTER ST STE A
BERLIN HEIGHTS OH
44814-9603
US

IV. Provider business mailing address

66 CENTER ST STE A
BERLIN HEIGHTS OH
44814-9603
US

V. Phone/Fax

Practice location:
  • Phone: 419-706-1581
  • Fax:
Mailing address:
  • Phone: 419-706-1581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.1901324
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC1700305
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.1901324
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: