Provider Demographics
NPI:1407121510
Name:BARTLEBAUGH, NADIRA (LPCC-S)
Entity Type:Individual
Prefix:
First Name:NADIRA
Middle Name:
Last Name:BARTLEBAUGH
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 1:25700 SCIENCE PARK DR STE 210
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7328
Mailing Address - Country:US
Mailing Address - Phone:216-450-1613
Mailing Address - Fax:216-450-1614
Practice Address - Street 1:29055 CLEMENS ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1135
Practice Address - Country:US
Practice Address - Phone:216-450-1613
Practice Address - Fax:216-450-1614
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1000059-SUPV101YA0400X, 101YM0800X, 101YP2500X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker