Healthcare Provider Details

I. General information

NPI: 1922577709
Provider Name (Legal Business Name): KATELYN DECOSTA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2018
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3751 BURRSHIRE DR NW
CANTON OH
44709-2229
US

IV. Provider business mailing address

123 BYERS AVE
AKRON OH
44302-1339
US

V. Phone/Fax

Practice location:
  • Phone: 330-413-0869
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2608427
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: