Healthcare Provider Details

I. General information

NPI: 1558482992
Provider Name (Legal Business Name): CLEARFIELD-JEFFERSON CMHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E MARKET ST
CLEARFIELD PA
16830-2468
US

IV. Provider business mailing address

501 E MARKET ST
CLEARFIELD PA
16830-2468
US

V. Phone/Fax

Practice location:
  • Phone: 814-371-1100
  • Fax: 814-375-0120
Mailing address:
  • Phone: 814-371-1100
  • Fax: 814-375-0120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number407300
License Number StatePA

VIII. Authorized Official

Name: KAREN H FORSHA
Title or Position: BILLING SUPERVISOR
Credential: B.S. EDUCATION
Phone: 814-371-1100