Healthcare Provider Details

I. General information

NPI: 1609941236
Provider Name (Legal Business Name): CONNELLSVILLE COUNSELING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S ARCH ST
CONNELLSVILLE PA
15425-3515
US

IV. Provider business mailing address

110 S ARCH ST
CONNELLSVILLE PA
15425-3515
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD-070419L
License Number StatePA

VIII. Authorized Official

Name: MR. CHRIS STERN
Title or Position: COO
Credential: ESQ.
Phone: 724-626-9941