Provider Demographics
NPI:1821465634
Name:KHATRI, BHAGWANTI
Entity Type:Individual
Prefix:
First Name:BHAGWANTI
Middle Name:
Last Name:KHATRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2848 AARON DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-7970
Mailing Address - Country:US
Mailing Address - Phone:330-762-9377
Mailing Address - Fax:
Practice Address - Street 1:2848 AARON DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-7970
Practice Address - Country:US
Practice Address - Phone:330-762-9377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)