1912123449 NPI number — MISS KELLEY BETH MCNICHOLS MSED, LPC, CAC, CCDP

Table of content: DR. MICHAEL BINGHAM O.D (NPI 1699156018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912123449 NPI number — MISS KELLEY BETH MCNICHOLS MSED, LPC, CAC, CCDP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCNICHOLS
Provider First Name:
KELLEY
Provider Middle Name:
BETH
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MSED, LPC, CAC, CCDP
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:
1912123449
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:
164 MICHIGAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOWER BURRELL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15068-2932
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-994-9221
Provider Business Mailing Address Fax Number:
412-244-4550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
355 5TH AVE
Provider Second Line Business Practice Location Address:
PARK BUILDING, SUITE 410
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15222-2409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-244-4550
Provider Business Practice Location Address Fax Number:
412-244-4550
Provider Enumeration Date:
04/17/2007

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: 101YA0400X , with the licence number:  PC004214 , 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)





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