Healthcare Provider Details

I. General information

NPI: 1487526091
Provider Name (Legal Business Name): MYA FETTY MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W CRAWFORD AVE
CONNELLSVILLE PA
15425-3527
US

IV. Provider business mailing address

150 W CRAWFORD AVE
CONNELLSVILLE PA
15425-3527
US

V. Phone/Fax

Practice location:
  • Phone: 724-626-9941
  • Fax: 724-626-2785
Mailing address:
  • Phone: 724-926-9941
  • Fax: 724-626-2785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC001032
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: