Healthcare Provider Details

I. General information

NPI: 1609387638
Provider Name (Legal Business Name): KRIS L VITALE LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8080 BECKETT CENTER DR STE 217
WEST CHESTER OH
45069-5037
US

IV. Provider business mailing address

8080 BECKETT CENTER DR STE 217
WEST CHESTER OH
45069-5037
US

V. Phone/Fax

Practice location:
  • Phone: 513-881-0910
  • Fax:
Mailing address:
  • Phone: 513-881-0910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC161651
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE1700396
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE1700396
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: