Provider Demographics
NPI:1255605689
Name:PEPERA, KRISTEN L (LPCC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:L
Last Name:PEPERA
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1371 MARVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2339
Mailing Address - Country:US
Mailing Address - Phone:330-204-0457
Mailing Address - Fax:
Practice Address - Street 1:21139 LORAIN RD STE 12
Practice Address - Street 2:
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-2149
Practice Address - Country:US
Practice Address - Phone:330-529-5667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1100213101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHYRP098M70705OtherANTHEM BLUE ACCESS PPO