Provider Demographics
NPI:1609387638
Name:VITALE, KRIS L (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:KRIS
Middle Name:L
Last Name:VITALE
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 1:8080 BECKETT CENTER DR STE 217
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-5037
Mailing Address - Country:US
Mailing Address - Phone:513-881-0910
Mailing Address - Fax:
Practice Address - Street 1:8080 BECKETT CENTER DR STE 217
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-5037
Practice Address - Country:US
Practice Address - Phone:513-881-0910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC161651101YA0400X
OHE1700396101YM0800X, 101YP2500X
261QC1800X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)