Healthcare Provider Details

I. General information

NPI: 1285544064
Provider Name (Legal Business Name): TORILYNNE HETRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4012 MAIN ST STE 2
HAWTHORN PA
16230
US

IV. Provider business mailing address

405 DEANVILLE RD
NEW BETHLEHEM PA
16242-6725
US

V. Phone/Fax

Practice location:
  • Phone: 814-275-1237
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC002847
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: