MEDICARE: NEW HOPE COUNSELING SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	PC007269	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PC007269	OTHER	PA	LPC

General Provider Information

NPI Number	:	1184013104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW HOPE COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	1205 PEACH ST
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16501-1807
Country	:	US
Telephone Number	:	814-528-5711
Fax Number	:

Provider Business Practice Location Address
First Line	:	1205 PEACH ST
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16501-1807
Country	:	US
Telephone Number	:	814-528-5711
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL COUNSELOR
Name	:	MRS. DIANE LYNN KOOS
Credential	:	LPC
Telephone Number	:	814-528-5711

Provider Enumeration Date	:	01/14/2015
Last Update Date	:	01/29/2016

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Directions to “NEW HOPE COUNSELING SERVICES ” Practice Location

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