Provider Demographics
NPI:1528539707
Name:FORTUNATO, KATELYN MEGHANN (LPC)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:MEGHANN
Last Name:FORTUNATO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:MEGHANN
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:4531 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1051
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4531 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1051
Practice Address - Country:US
Practice Address - Phone:330-904-4068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1500336101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health