Provider Demographics
NPI:1669916219
Name:CAUGHELL, KATHLEEN (LICDC-CS)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:
Last Name:CAUGHELL
Suffix:
Gender:F
Credentials:LICDC-CS
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:KOELSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICDC-CS
Mailing Address - Street 1:1590 COAL RUN RD
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701
Mailing Address - Country:US
Mailing Address - Phone:740-297-4417
Mailing Address - Fax:740-487-1461
Practice Address - Street 1:1590 COAL RUN RD
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701
Practice Address - Country:US
Practice Address - Phone:740-297-4417
Practice Address - Fax:740-487-1461
Is Sole Proprietor?:No
Enumeration Date:2016-12-15
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH943937101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)