MEDICARE: KRISTIN MCCONNELL LPCC

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	101YM0800X	Mental Health Counselor	005280	NY
2	101YP2500X	Professional Counselor	PC007679	PA
3	101YP2500X	Professional Counselor	E.2303534	OH
4	101Y00000X	Counselor

General Provider Information

NPI Number	:	1598997934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN MCCONNELL LPCC

Provider Business Mailing Address
First Line	:	857 THIRLWALL CT
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43081-2751
Country	:	US
Telephone Number	:	614-804-4806
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 S STATE ST
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43081-2233
Country	:	US
Telephone Number	:	614-804-4806
Fax Number	:

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

Provider Enumeration Date	:	08/19/2009
Last Update Date	:	10/05/2023

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