Healthcare Provider Details

I. General information

NPI: 1003365560
Provider Name (Legal Business Name): NAMASTE HOLISTIC COUNSELING PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1056 CORPORATE LN
EXPORT PA
15632
US

IV. Provider business mailing address

PO BOX 2124
LOWER BURRELL PA
15068-1524
US

V. Phone/Fax

Practice location:
  • Phone: 412-639-9570
  • Fax: 724-704-8164
Mailing address:
  • Phone: 412-639-9570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC007650
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier1821401746
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerINDIVIDUAL NPI
# 2
Identifier1649408592
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK AND OPTUM
# 3
Identifier1598855884
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK AND OPTUM
# 4
Identifier1053744409
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK AND OPTUM

VIII. Authorized Official

Name: MRS. CRYSAL LONGANECKER
Title or Position: OWNER PRESIDENT
Credential: MA,MFT,LPC
Phone: 412-639-9570