Healthcare Provider Details

I. General information

NPI: 1750938270
Provider Name (Legal Business Name): EDWARD P. KECHISEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 LEONARD ST
CLEARFIELD PA
16830-3200
US

IV. Provider business mailing address

34 ESTEP LN
OSCEOLA MILLS PA
16666-1561
US

V. Phone/Fax

Practice location:
  • Phone: 814-205-4004
  • Fax:
Mailing address:
  • Phone: 814-592-0469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number002469
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: