Healthcare Provider Details

I. General information

NPI: 1184664344
Provider Name (Legal Business Name): MRS. AMY DIANE KLEISSAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSYCHOLOGICAL ASSOCIATES INC STE 204
ALLISON PARK PA
15101
US

IV. Provider business mailing address

PSYCHOLOGICAL ASSOCIATES INC STE 204
ALLISON PARK PA
15101
US

V. Phone/Fax

Practice location:
  • Phone: 412-486-2948
  • Fax: 412-486-5676
Mailing address:
  • Phone: 412-486-2948
  • Fax: 412-486-5676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC001422
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: