Healthcare Provider Details

I. General information

NPI: 1518496751
Provider Name (Legal Business Name): MATTHEW BRITTSAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MATT BRITTSAN

II. Dates (important events)

Enumeration Date: 06/10/2017
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 STOVER DR
DELAWARE OH
43015-8601
US

IV. Provider business mailing address

171 WHITE ELM DR
DELAWARE OH
43015-3451
US

V. Phone/Fax

Practice location:
  • Phone: 740-417-9265
  • Fax:
Mailing address:
  • Phone: 614-205-5058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2001607
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: