Healthcare Provider Details

I. General information

NPI: 1780835041
Provider Name (Legal Business Name): ASHLEY N. KLINGELSMITH M.ED., PCC-S, IMFT-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 W MAPLE ST STE 102
NORTH CANTON OH
44720-2858
US

IV. Provider business mailing address

930 W COMET RD
NEW FRANKLIN OH
44216-9601
US

V. Phone/Fax

Practice location:
  • Phone: 330-705-3073
  • Fax:
Mailing address:
  • Phone: 330-705-3073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.0700438
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberF.1500026
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: