Healthcare Provider Details

I. General information

NPI: 1417371311
Provider Name (Legal Business Name): PSYCHOLOGICAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2014
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

956 WEST 38TH STREET
ERIE PA
16508
US

IV. Provider business mailing address

956 WEST 38TH STREET
ERIE PA
16508
US

V. Phone/Fax

Practice location:
  • Phone: 814-864-9719
  • Fax: 814-866-1174
Mailing address:
  • Phone: 814-864-9719
  • Fax: 814-866-1174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. TED S. URBAN
Title or Position: OWNER
Credential: ED.D.
Phone: 814-864-9719