1235552720 NPI number — SAND CATLE COUNSELING

Table of content: (NPI 1235552720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235552720 NPI number — SAND CATLE COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAND CATLE COUNSELING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1235552720
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
527 W CHOCOLATE AVE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
HERSHEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17033-1663
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-525-0558
Provider Business Mailing Address Fax Number:
717-533-2169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
527 W CHOCOLATE AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
HERSHEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17033-1663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-525-0558
Provider Business Practice Location Address Fax Number:
717-533-2169
Provider Enumeration Date:
02/04/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BATES-SIER
Authorized Official First Name:
DIANE
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
OWNER/THERAPIST
Authorized Official Telephone Number:
717-525-0558

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  CW009345 , 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)