Provider Demographics
NPI:1508089160
Name:PACEY, KATHERYN M (PHD)
Entity Type:Individual
Prefix:
First Name:KATHERYN
Middle Name:M
Last Name:PACEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10901 REED HARTMAN HWY STE 116
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-2847
Mailing Address - Country:US
Mailing Address - Phone:513-600-3570
Mailing Address - Fax:502-855-5065
Practice Address - Street 1:10901 REED HARTMAN HWY STE 116
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-2847
Practice Address - Country:US
Practice Address - Phone:513-600-3570
Practice Address - Fax:513-827-9285
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5813103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2278315Medicaid
OH2278315Medicaid