1457471294 NPI number — MS. BONNIE LYNNE SHEVOCK LPC

Table of content: MS. BONNIE LYNNE SHEVOCK LPC (NPI 1457471294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457471294 NPI number — MS. BONNIE LYNNE SHEVOCK LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHEVOCK
Provider First Name:
BONNIE
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457471294
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
481 CARBON CENTER ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUTLER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-282-8276
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 EAST JEFFERSON ST
Provider Second Line Business Practice Location Address:
SAMARITAN COUNSELING CENTER
Provider Business Practice Location Address City Name:
BUTLER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-287-2567
Provider Business Practice Location Address Fax Number:
412-741-7430
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  PC002930 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1465775 . This is a "HIGHMARK BLUE CROSS BLUE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 11634100 . This is a "CAQH UNITED BEHAVIORAL HE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com