Healthcare Provider Details

I. General information

NPI: 1730865486
Provider Name (Legal Business Name): JMW COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 E DRINKER ST
DUNMORE PA
18512-2549
US

IV. Provider business mailing address

629 E DRINKER ST
DUNMORE PA
18512-2549
US

V. Phone/Fax

Practice location:
  • Phone: 570-851-7408
  • Fax:
Mailing address:
  • Phone: 570-851-7408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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:

# 1
Identifier1679144422
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerNPI

VIII. Authorized Official

Name: DR. JENNY MARIE WILDRICK
Title or Position: PROFESSIONAL COUNSELOR
Credential: PH.D. LPC CRC CPRP
Phone: 570-851-7408