Healthcare Provider Details

I. General information

NPI: 1073437695
Provider Name (Legal Business Name): MR. RUTCHANON ASAVATESANON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHARLES ASAVATESANON

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 WESTERN AVE
PITTSBURGH PA
15233-1772
US

IV. Provider business mailing address

717 LIBERTY AVE APT 901
PITTSBURGH PA
15222-3532
US

V. Phone/Fax

Practice location:
  • Phone: 412-322-2129
  • Fax:
Mailing address:
  • Phone: 979-789-4289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: