Basic Information
Provider Information
NPI: 1467068106
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BATYK
FirstName: PHILIP
MiddleName: S
NamePrefix:  
NameSuffix:  
Credential: CDCA,QMHS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2845 BELL ST
Address2:  
City: ZANESVILLE
State: OH
PostalCode: 437011720
CountryCode: US
TelephoneNumber: 7404549766
FaxNumber: 7405886452
Practice Location
Address1: 121 N 18TH ST
Address2:  
City: CAMBRIDGE
State: OH
PostalCode: 437252501
CountryCode: US
TelephoneNumber: 7404325130
FaxNumber: 7404325345
Other Information
ProviderEnumerationDate: 09/18/2020
LastUpdateDate: 09/18/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/18/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
171M00000X  N Other Service ProvidersCase Manager/Care Coordinator 
101YA0400XCDCA.174262OHY Behavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)

No ID Information.


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