Provider Demographics
NPI:1750930657
Name:WOLF, KRISTYN (LPCC-S)
Entity type:Individual
Prefix:
First Name:KRISTYN
Middle Name:
Last Name:WOLF
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 MARKET ST STE C
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-2119
Mailing Address - Country:US
Mailing Address - Phone:330-397-9878
Mailing Address - Fax:
Practice Address - Street 1:4800 MARKET ST STE C
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-2119
Practice Address - Country:US
Practice Address - Phone:330-397-9878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1801153-TRNE171M00000X
OHE.2102505-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE.2102505-SUPVOtherCSWMFT BOARD
OHC1902298OtherOCSMFTB