Basic Information
| Provider Information | |||||||||
| NPI: | 1205134988 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARGA | ||||||||
| FirstName: | MIKA | ||||||||
| MiddleName: | KAY | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPC-CR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 208 W PARK DR | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453312370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374170091 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 212 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453311913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375481635 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2011 | ||||||||
| LastUpdateDate: | 03/04/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | C.0900225 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 01135 | 01 | OH | UPIN | OTHER | 0959440 | 05 | OH | MEDICAID | 9249691 | 01 | OH | MEDICARE | OTHER |