Provider Demographics
NPI:1750301834
Name:BADEAU, WALTER ED (LPC, CAC)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:ED
Last Name:BADEAU
Suffix:
Gender:M
Credentials:LPC, CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:PA
Mailing Address - Zip Code:15853-1939
Mailing Address - Country:US
Mailing Address - Phone:814-776-2145
Mailing Address - Fax:814-776-1470
Practice Address - Street 1:220 PARADE ST
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-1253
Practice Address - Country:US
Practice Address - Phone:814-776-2145
Practice Address - Fax:814-776-1470
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000046101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor