Healthcare Provider Details

I. General information

NPI: 1689080640
Provider Name (Legal Business Name): TREVOR GARTENHAUS MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 7TH ST
PARKERSBURG WV
26101-3803
US

IV. Provider business mailing address

2121 7TH ST
PARKERSBURG WV
26101-3803
US

V. Phone/Fax

Practice location:
  • Phone: 304-485-1721
  • Fax: 304-684-2656
Mailing address:
  • Phone: 304-485-1721
  • Fax: 304-684-2656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: