Healthcare Provider Details

I. General information

NPI: 1912479536
Provider Name (Legal Business Name): TAYLOR KAITLIN FATE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2018
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 ELSINORE PL STE 500
CINCINNATI OH
45202-1455
US

IV. Provider business mailing address

615 ELSINORE PL STE 500
CINCINNATI OH
45202-1455
US

V. Phone/Fax

Practice location:
  • Phone: 513-231-6630
  • Fax:
Mailing address:
  • Phone: 513-231-6630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.1801442-TRNE
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2002705
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2002705
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: