Healthcare Provider Details

I. General information

NPI: 1366087017
Provider Name (Legal Business Name): MARY KATHRYN TUREK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2019
Last Update Date: 11/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1416 MONROE AVE STE 205
DUNMORE PA
18509-2477
US

IV. Provider business mailing address

4371 W MOUNTAIN VIEW DR
WALNUTPORT PA
18088-9730
US

V. Phone/Fax

Practice location:
  • Phone: 570-952-4180
  • Fax: 570-254-6337
Mailing address:
  • Phone: 570-952-4180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC011578
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: