Provider Demographics
NPI:1215561279
Name:KETOLA, JOSHUA ADAM (CIT)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ADAM
Last Name:KETOLA
Suffix:
Gender:M
Credentials:CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1064
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44003-1064
Mailing Address - Country:US
Mailing Address - Phone:440-661-1920
Mailing Address - Fax:
Practice Address - Street 1:580 GRANT ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-9910
Practice Address - Country:US
Practice Address - Phone:330-376-9494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health