Provider Demographics
NPI:1891082806
Name:KONING, KATELYN LEE (LPC)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:LEE
Last Name:KONING
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:238 JEWETT AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-2845
Mailing Address - Country:US
Mailing Address - Phone:203-372-4301
Mailing Address - Fax:203-373-0835
Practice Address - Street 1:238 JEWETT AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-2845
Practice Address - Country:US
Practice Address - Phone:203-372-4301
Practice Address - Fax:203-373-0835
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002073101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004040655Medicaid