Provider Demographics
NPI:1235202730
Name:WAECHTER, MINDY K (NM LPCC AND OH LPC)
Entity Type:Individual
Prefix:MS
First Name:MINDY
Middle Name:K
Last Name:WAECHTER
Suffix:
Gender:F
Credentials:NM LPCC AND OH LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 CLEARMOUNT AVE SE
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-3704
Mailing Address - Country:US
Mailing Address - Phone:330-499-0477
Mailing Address - Fax:
Practice Address - Street 1:4735 BELPAR ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3648
Practice Address - Country:US
Practice Address - Phone:330-493-9822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC-0007737101YM0800X
NM3186101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health