Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | E6835 | OH |
N | 101YM0800X | Mental Health Counselor | E6835 | OH |
N | 101YP1600X | Pastoral Counselor | E6835 | OH |
N | 101YP2500X | Professional Counselor | E6835 | OH |
NPI | 1194888792 |
---|---|
Provider Name | Mr. Matt Pavlik |
First Address | Dayton, OH 45459-4221 |
Second Address | Dayton, OH 45459-4221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 21/04/2021 |