Provider Demographics
NPI:1215205067
Name:KALETA, DAVID A (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:KALETA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PUBLIC SQ
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-7843
Mailing Address - Country:US
Mailing Address - Phone:910-880-1747
Mailing Address - Fax:
Practice Address - Street 1:12 PUBLIC SQ
Practice Address - Street 2:SUITE 3
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-7843
Practice Address - Country:US
Practice Address - Phone:910-880-1747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE2370101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health