1790338739 NPI number — ALYSHA MARIE BALONIS LPC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790338739 NPI number — ALYSHA MARIE BALONIS LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALONIS
Provider First Name:
ALYSHA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
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:
BIXLER
Provider Other First Name:
ALYSHA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790338739
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
704 E GRAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOWER CITY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17980-1216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-991-3310
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
704 E GRAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOWER CITY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17980-1216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-461-2014
Provider Business Practice Location Address Fax Number:
717-647-2573
Provider Enumeration Date:
07/18/2019

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:  PC011516 , 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: 1036767410003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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