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General NPI Number Information
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NPI Number | 1265740054
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Entity Type | Individual
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Provider Name | CRYSTAL SUETHOLZ LPCC
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Gender | Female
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Dates
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Enumeration Date | 09/15/2010
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 688 BRANDTLY RIDGE DR
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City | COVINGTON
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State | KY
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Zip | 41015-4228
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Country | US
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Telephone | 596-094-4548
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Fax |
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Provider Business Mailing Address
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Address Line | 688 BRANDTLY RIDGE DR
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City | COVINGTON
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State | KY
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Zip | 41015-4228
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Country | US
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Telephone | 859-609-4454
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 174800
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 174800
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CC6925
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License Number State | ME
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C7434
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License Number State | OR
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Taxonomy #5
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E.1000088
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License Number State | OH
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Taxonomy #6
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C7434
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License Number State | OR
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Taxonomy #7
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CC6925
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License Number State | ME
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Taxonomy #8
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | E.1000088
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License Number State | OH
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