MEDICARE: MARK JONATHAN BRITTEN LPC

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	PC001110	PA

General Provider Information

NPI Number	:	1487720876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK JONATHAN BRITTEN LPC

Provider Business Mailing Address
First Line	:	105 WEST AVE
Second Line	:
City	:	WELLSBORO
State	:	PA
Zip	:	16901-1358
Country	:	US
Telephone Number	:	570-723-0620
Fax Number	:	570-724-0675

Provider Business Practice Location Address
First Line	:	1965 LYCOMING CREEK RD
Second Line	:
City	:	WILLIAMSPORT
State	:	PA
Zip	:	17701-1294
Country	:	US
Telephone Number	:	570-326-0532
Fax Number	:	570-326-7301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/08/2007

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