Healthcare Provider Details

I. General information

NPI: 1831772003
Provider Name (Legal Business Name): MOUNTAINHOME COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1056 ROUTE 390
CRESCO PA
18326-7908
US

IV. Provider business mailing address

110 WYWAMIC RD
CRESCO PA
18326-7453
US

V. Phone/Fax

Practice location:
  • Phone: 570-213-9139
  • Fax:
Mailing address:
  • Phone: 201-965-1828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BRITTAN CALDERONE
Title or Position: OWNER
Credential: LPC
Phone: 201-965-1828