Provider Demographics
NPI:1710282579
Name:BERTIN, MEREDITH KATHLEEN (LPC)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:KATHLEEN
Last Name:BERTIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2301
Mailing Address - Country:US
Mailing Address - Phone:740-594-5045
Mailing Address - Fax:740-594-5045
Practice Address - Street 1:90 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2301
Practice Address - Country:US
Practice Address - Phone:740-594-5045
Practice Address - Fax:740-594-5045
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0900528101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional