Basic Information
| Provider Information | |||||||||
| NPI: | 1538533526 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KORTANEK | ||||||||
| FirstName: | KATE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LPCC-S, ATR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24800 CHAGRIN BLVD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | BEACHWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441225648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162456231 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 24800 CHAGRIN BLVD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | BEACHWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441225648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162456231 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2015 | ||||||||
| LastUpdateDate: | 11/14/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | C. 0900546-SUPV | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.