Healthcare Provider Details

I. General information

NPI: 1487853396
Provider Name (Legal Business Name): PSYCHOLOGICAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

956 W 38TH ST
ERIE PA
16508-2531
US

IV. Provider business mailing address

956 W 38TH ST
ERIE PA
16508-2531
US

V. Phone/Fax

Practice location:
  • Phone: 814-864-9719
  • Fax: 814-866-1174
Mailing address:
  • Phone: 814-864-9719
  • Fax: 814-666-1174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC004502
License Number StatePA

VIII. Authorized Official

Name: MICHELLE M CURTZE
Title or Position: PROFESSIONAL COUNSELOR
Credential: MA
Phone: 814-864-9719