1881728194 NPI number — NORTHERN TIER COUNSELING, INC

Table of content: (NPI 1881728194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881728194 NPI number — NORTHERN TIER COUNSELING, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN TIER COUNSELING, INC
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:
1881728194
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24727 ROUTE 6
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
TOWANDA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18848-8257
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-265-0100
Provider Business Mailing Address Fax Number:
570-265-6741

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24727 ROUTE 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOWANDA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18848-8257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-265-0100
Provider Business Practice Location Address Fax Number:
570-268-2756
Provider Enumeration Date:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DENAULT
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
570-265-0100

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X , with the licence number:  221030 , 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: 000753722 . This is a "HIGHMARK ID#-PSYCHIATRY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007540580103 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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