Provider Demographics
NPI:1295127702
Name:FLEGAL, KATY (MS, LCDC III)
Entity type:Individual
Prefix:
First Name:KATY
Middle Name:
Last Name:FLEGAL
Suffix:
Gender:F
Credentials:MS, LCDC III
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:R
Other - Last Name:HAURIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30800 CHAGRIN BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44124-5925
Mailing Address - Country:US
Mailing Address - Phone:216-292-2073
Mailing Address - Fax:216-591-1243
Practice Address - Street 1:30800 CHAGRIN BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44124-5925
Practice Address - Country:US
Practice Address - Phone:216-292-2073
Practice Address - Fax:216-591-1243
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-21
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH141297101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2374229Medicaid