Healthcare Provider Details

I. General information

NPI: 1710656913
Provider Name (Legal Business Name): KATELYN A HAMPU LPC, CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4641 FULTON DR NW
CANTON OH
44718-2384
US

IV. Provider business mailing address

3007 TREESIDE ST NW
CANTON OH
44709-1906
US

V. Phone/Fax

Practice location:
  • Phone: 330-433-6075
  • Fax: 330-433-1843
Mailing address:
  • Phone: 216-301-7155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.180390
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2304878
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: