Provider Demographics
NPI:1215993746
Name:PAE, KATHLEEN B (LPC)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:B
Last Name:PAE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:A
Other - Last Name:BLACKBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:3800 WEST 12TH STREET
Mailing Address - Street 2:STE 5
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-3380
Mailing Address - Country:US
Mailing Address - Phone:814-838-2282
Mailing Address - Fax:814-969-7730
Practice Address - Street 1:3800 WEST 12TH STREET
Practice Address - Street 2:STE 5
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-3380
Practice Address - Country:US
Practice Address - Phone:814-838-2282
Practice Address - Fax:814-969-7730
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACAC NUMBER 0512101YA0400X
PAPC000654101YP2500X
PAPC 000654101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)