Healthcare Provider Details

I. General information

NPI: 1396135950
Provider Name (Legal Business Name): COMMUNITY GUIDANCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 LEONARD ST
CLEARFIELD PA
16830-3247
US

IV. Provider business mailing address

793 OLD ROUTE 119 HWY N
INDIANA PA
15701-1372
US

V. Phone/Fax

Practice location:
  • Phone: 724-465-5576
  • Fax: 724-465-6379
Mailing address:
  • Phone: 724-465-5576
  • Fax: 724-465-6379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DARRIN JAMES MIKULA
Title or Position: CFO
Credential:
Phone: 724-465-5576