Provider Demographics
NPI:1235683400
Name:BARTKUS, MARY LOU (LPCC-S)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LOU
Last Name:BARTKUS
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1276 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-1514
Mailing Address - Country:US
Mailing Address - Phone:216-443-5630
Mailing Address - Fax:216-443-8272
Practice Address - Street 1:1276 W 3RD ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-1514
Practice Address - Country:US
Practice Address - Phone:216-443-5630
Practice Address - Fax:216-443-8272
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE. 0003048101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional