Healthcare Provider Details

I. General information

NPI: 1295575009
Provider Name (Legal Business Name): CATHERINE MARIE GELETKA MA-LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 05/29/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24803 DETROIT RD UNIT E
WESTLAKE OH
44145-2553
US

IV. Provider business mailing address

1401 W 75TH ST APT C
CLEVELAND OH
44102-2973
US

V. Phone/Fax

Practice location:
  • Phone: 216-910-4678
  • Fax:
Mailing address:
  • Phone: 440-785-7403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2103803
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: