Provider Demographics
NPI:1275180978
Name:BEARER, KATHERINE E (LPC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:BEARER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:E
Other - Last Name:SARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:DEPT 781629
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1629
Mailing Address - Country:US
Mailing Address - Phone:614-355-8004
Mailing Address - Fax:614-355-2220
Practice Address - Street 1:655 E LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2618
Practice Address - Country:US
Practice Address - Phone:614-722-8293
Practice Address - Fax:614-722-8299
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1902016101YM0800X
OHE.2102138101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1473276Medicaid