Healthcare Provider Details

I. General information

NPI: 1003786302
Provider Name (Legal Business Name): BACK MOUNTAIN MUSIC THERAPY, THE HEYWARD ROOMS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2025
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 TWIN STACKS DR
DALLAS PA
18612-8505
US

IV. Provider business mailing address

1108 TWIN STACKS DR
DALLAS PA
18612-8505
US

V. Phone/Fax

Practice location:
  • Phone: 570-574-1707
  • Fax:
Mailing address:
  • Phone: 570-574-1707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANTOINETTE MORRISON
Title or Position: OWNER/ MUSIC THERAPIST
Credential: MT-BC
Phone: 570-574-6822