MEDICARE: KATHERINE STOLL LPC-CR, CDCA 1

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCA.150120-PRE	OH
2	101YM0800X	Mental Health Counselor	C.1300701	OH

General Provider Information

NPI Number	:	1033590914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE STOLL LPC-CR, CDCA 1

Provider Business Mailing Address
First Line	:	700 W PETE ROSE WAY
Second Line	:	SUITE 349
City	:	CINCINNATI
State	:	OH
Zip	:	45203-1892
Country	:	US
Telephone Number	:	513-834-7050
Fax Number	:	513-834-7052

Provider Business Practice Location Address
First Line	:	700 W PETE ROSE WAY
Second Line	:	SUITE 349
City	:	CINCINNATI
State	:	OH
Zip	:	45203-1892
Country	:	US
Telephone Number	:	513-834-7050
Fax Number	:	513-834-7052

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2015
Last Update Date	:	06/18/2015

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