Healthcare Provider Details

I. General information

NPI: 1841497963
Provider Name (Legal Business Name): EVELYN JANET WALD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 S PENNSYLVANIA AVENUE
CENTRE HALL PA
16828
US

IV. Provider business mailing address

PO BOX 98 241 S PENNSYLVANIA AVENUE
CENTRE HALL PA
16828
US

V. Phone/Fax

Practice location:
  • Phone: 814-364-1130
  • Fax:
Mailing address:
  • Phone: 814-364-1130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberPC000627
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: