MEDICARE: NADIRA BARTLEBAUGH LPCC-S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	E.1000059-SUPV	OH
2	101YM0800X	Mental Health Counselor	E.1000059-SUPV	OH
3	104100000X	Social Worker
4	101YP2500X	Professional Counselor	E.1000059-SUPV	OH

General Provider Information

NPI Number	:	1407121510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADIRA BARTLEBAUGH LPCC-S

Provider Business Mailing Address
First Line	:	25700 SCIENCE PARK DR STE 210
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-7328
Country	:	US
Telephone Number	:	216-450-1613
Fax Number	:	216-450-1614

Provider Business Practice Location Address
First Line	:	29055 CLEMENS ROAD
Second Line	:	SUITE A
City	:	WESTLAKE
State	:	OH
Zip	:	44145-1135
Country	:	US
Telephone Number	:	216-450-1613
Fax Number	:	216-450-1614

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2012
Last Update Date	:	11/22/2020

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