MEDICARE: CHRISTOPHER RYAN BERTIAUX MA, LPC, LAC, NCC

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	101YP2500X	Professional Counselor	016248	GA
2	101YP2500X	Professional Counselor	9636	SC

General Provider Information

NPI Number	:	1598418170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER RYAN BERTIAUX MA, LPC, LAC, NCC

Provider Business Mailing Address
First Line	:	1314 WATERVISTA TER
Second Line	:
City	:	POOLER
State	:	GA
Zip	:	31322-5503
Country	:	US
Telephone Number	:	843-321-7881
Fax Number	:

Provider Business Practice Location Address
First Line	:	1314 WATERVISTA TER
Second Line	:
City	:	POOLER
State	:	GA
Zip	:	31322-5503
Country	:	US
Telephone Number	:	843-321-7881
Fax Number	:

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

Provider Enumeration Date	:	02/02/2022
Last Update Date	:	04/08/2026

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