Provider Demographics
NPI:1497275663
Name:KORTANEK, CASEY LAUREN (LCDC III)
Entity Type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:LAUREN
Last Name:KORTANEK
Suffix:
Gender:F
Credentials:LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5720 GATEWAY STE 204
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-1891
Mailing Address - Country:US
Mailing Address - Phone:513-445-9959
Mailing Address - Fax:
Practice Address - Street 1:5720 GATEWAY STE 204
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-1891
Practice Address - Country:US
Practice Address - Phone:513-445-9959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2305256-TRNE101Y00000X, 101YM0800X
OH162966101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)