Healthcare Provider Details

I. General information

NPI: 1073476354
Provider Name (Legal Business Name): MIKE JOSEPH IWINSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 11/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3361 PA- 130
HARRISON CITY PA
15636
US

IV. Provider business mailing address

3361 PA- 130
HARRISON CITY PA
15636
US

V. Phone/Fax

Practice location:
  • Phone: 724-433-9593
  • Fax:
Mailing address:
  • Phone: 724-433-9593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: