Basic Information
Provider Information
NPI: 1003004409
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARTASHUS
FirstName: WALTER
MiddleName: ANDREW
NamePrefix: MR.
NameSuffix:  
Credential: LPCC-S
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2803 AKRON RD
Address2:  
City: WOOSTER
State: OH
PostalCode: 446917904
CountryCode: US
TelephoneNumber: 3302643232
FaxNumber: 3302023883
Practice Location
Address1: 2803 AKRON RD
Address2:  
City: WOOSTER
State: OH
PostalCode: 446917904
CountryCode: US
TelephoneNumber: 3302643232
FaxNumber: 3302023883
Other Information
ProviderEnumerationDate: 10/10/2007
LastUpdateDate: 10/10/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XE 0002801 SUPVOHY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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