Healthcare Provider Details

I. General information

NPI: 1134867930
Provider Name (Legal Business Name): KRD COUNSELING AND WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 S 2ND AVE
CLARION PA
16214-2464
US

IV. Provider business mailing address

162 S 2ND AVE STE D
CLARION PA
16214-2464
US

V. Phone/Fax

Practice location:
  • Phone: 824-299-6402
  • Fax:
Mailing address:
  • Phone: 814-900-4510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: KARI OVERHEIM
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 814-299-6402