Provider Demographics
NPI:1922524735
Name:KLEMENS, MARIE CHRISTINE (MA LPCC LCDC III)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:CHRISTINE
Last Name:KLEMENS
Suffix:
Gender:F
Credentials:MA LPCC LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 CLEVELAND AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44702-1805
Mailing Address - Country:US
Mailing Address - Phone:330-455-0374
Mailing Address - Fax:330-453-6716
Practice Address - Street 1:601 CLEVELAND AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44702-1836
Practice Address - Country:US
Practice Address - Phone:330-455-0374
Practice Address - Fax:330-453-6716
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCIII.161767101YA0400X
OHE.2203154101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0261366Medicaid