Healthcare Provider Details

I. General information

NPI: 1134781859
Provider Name (Legal Business Name): KIMBERLY KOTIK LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24500 CENTER RIDGE RD STE 200
WESTLAKE OH
44145-5630
US

IV. Provider business mailing address

24500 CENTER RIDGE RD STE 200
WESTLAKE OH
44145-5630
US

V. Phone/Fax

Practice location:
  • Phone: 440-201-4488
  • Fax: 440-385-7019
Mailing address:
  • Phone: 440-201-4488
  • Fax: 440-385-7019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2505301
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: