Healthcare Provider Details

I. General information

NPI: 1467520080
Provider Name (Legal Business Name): SAMARITAN COUNSELING CENTER OF THE SOUTHERN TIER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E MAIN STREET
ENDICOTT NY
13760
US

IV. Provider business mailing address

202 E MAIN STREET
ENDICOTT NY
13760
US

V. Phone/Fax

Practice location:
  • Phone: 607-754-2660
  • Fax: 607-754-0769
Mailing address:
  • Phone: 607-754-2660
  • Fax: 607-754-0769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MARIAN L TOWERS
Title or Position: EXECUTIVE DIRECTOR CEO
Credential:
Phone: 607-754-2660