Healthcare Provider Details

I. General information

NPI: 1134003742
Provider Name (Legal Business Name): KAITLYN KARAM COUNSELOR TRAINEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 NORTHWOODS BLVD
COLUMBUS OH
43235-4720
US

IV. Provider business mailing address

3166 S DORCHESTER RD
COLUMBUS OH
43221-2637
US

V. Phone/Fax

Practice location:
  • Phone: 614-636-2120
  • Fax:
Mailing address:
  • Phone: 513-578-5779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2608207
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: