Healthcare Provider Details

I. General information

NPI: 1215592209
Provider Name (Legal Business Name): MVCOUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 S STATE ST
CLARKS SUMMIT PA
18411-1684
US

IV. Provider business mailing address

209 ASHMORE AVE
CLARKS SUMMIT PA
18411-1562
US

V. Phone/Fax

Practice location:
  • Phone: 570-479-3835
  • Fax:
Mailing address:
  • Phone: 570-877-3140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MITCHELL L VALBURG
Title or Position: SOLE MEMBER
Credential: M.S., L.P.C.
Phone: 570-877-3140