Basic Information
| Provider Information | |||||||||
| NPI: | 1518496751 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRITTSAN | ||||||||
| FirstName: | MATTHEW | ||||||||
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| OtherLastName: | BRITTSAN | ||||||||
| OtherFirstName: | MATT | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 171 WHITE ELM DR | ||||||||
| Address2: | |||||||||
| City: | DELAWARE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430153451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142055058 | ||||||||
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| Practice Location | |||||||||
| Address1: | 106 STOVER DR | ||||||||
| Address2: | |||||||||
| City: | DELAWARE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430158601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404179265 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2017 | ||||||||
| LastUpdateDate: | 01/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | E.2001607 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.