Provider Demographics
NPI:1902309461
Name:MASON, KATELYN (LPC)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:
Other - Last Name:BOLDT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PC
Mailing Address - Street 1:4119 WHIPPLE AVE NW STE B
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-4801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:141 BROAD BLVD STE 204
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-3817
Practice Address - Country:US
Practice Address - Phone:330-703-6578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1500315101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health