Kaitlyn R Kortokrax, LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Practice address

408 9TH St SW
Canton, OH 44707-4714

Phone

(330) 454-2000

NPI assigned

Aug 12, 2016

Last updated

Jul 14, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Miss Kaitlyn R Jackson Former name

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lifecare Family Health and Dental Center, Inc

  dba Canton Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Canton, OH
  • NPI 1013964923
  Medicare reassignment NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  OH, Professional

  Medicare reassignment NPD
• Lifecare Family Health and Dental Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Massillon, OH
  • NPI 1134959000
  NPD
• Lifecare Family Health and Dental Center, Inc

  dba Canton Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Canton, OH
  • NPI 1851592034
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1470960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626220800000",
    "number": "1447704937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 9TH ST SW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447074714",
            "telephone_number": "330-454-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 9TH ST SW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447074714",
            "telephone_number": "330-454-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "624 Market Ave N",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "OH",
            "postal_code": "447021017",
            "country_code": "US",
            "telephone_number": "330-493-4553 x108",
            "fax_number": "330-493-3761",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KORTOKRAX",
        "first_name": "KAITLYN",
        "middle_name": "R",
        "name_prefix": "Mrs.",
        "credential": "LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-12",
        "last_updated": "2021-07-14",
        "certification_date": "2021-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0267648",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAITLYN",
            "last_name": "JACKSON",
            "middle_name": "R",
            "prefix": "MISS",
            "credential": "LPC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Annie Elizabeth Koprivec
• Kimberly Kay Koprivec
• Myrna Kordab
• Khalil B Korkor, M.D.
• Sheila Marie Korosy
• Melanie M Kosco, PTA
• Jennifer S Kosmides, MS, RD, LD
• Rebecca J Kostelnik, M.A.,CCC/A
• Esther Kostich
• Panayiota Nanette Kounouzvelis, PC

• Professional Counselor in Canton, OH
• Providers in Canton, OH by specialty
• Professional Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.