Healthcare Provider Details

I. General information

NPI: 1801841614
Provider Name (Legal Business Name): STEPHEN MINICK LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 PEACH ST
ERIE PA
16509-2482
US

IV. Provider business mailing address

5100 PEACH ST
ERIE PA
16509-2482
US

V. Phone/Fax

Practice location:
  • Phone: 814-866-4500
  • Fax: 814-864-2677
Mailing address:
  • Phone: 814-866-4500
  • Fax: 814-864-2677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC000638
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: