Provider Demographics
NPI:1407373863
Name:STANFORTH, KAITLYN A (LPCC)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:A
Last Name:STANFORTH
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10921 REED HARTMAN HWY STE 133
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-2851
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10921 REED HARTMAN HWY STE 133
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-2851
Practice Address - Country:US
Practice Address - Phone:513-984-9838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-27
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2102448101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional