Provider Demographics
NPI:1699258889
Name:ELESON, CATHERINE ANN COPPAGE (CMHC, LPCA)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANN COPPAGE
Last Name:ELESON
Suffix:
Gender:F
Credentials:CMHC, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14022 ECHO HILL TRL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-5168
Mailing Address - Country:US
Mailing Address - Phone:317-652-1342
Mailing Address - Fax:
Practice Address - Street 1:1825 FRANKFORT AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-3101
Practice Address - Country:US
Practice Address - Phone:317-652-1342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY172586101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health