Healthcare Provider Details

I. General information

NPI: 1609889351
Provider Name (Legal Business Name): PATHWAY TO RECOVERY COUNSELING & EDUCATIONAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 05/14/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 WEST BROAD ST.
HAZLETON PA
18201
US

IV. Provider business mailing address

223 WEST BROAD ST.
HAZLETON PA
18201
US

V. Phone/Fax

Practice location:
  • Phone: 570-455-9902
  • Fax: 570-455-9452
Mailing address:
  • Phone: 570-455-9902
  • Fax: 570-455-9452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number226200
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number226200
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number226200
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number226200
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number226200
License Number StatePA
# 7
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number226200
License Number StatePA

VIII. Authorized Official

Name: MRS. KATIE PETROLE
Title or Position: PRESIDENT & CEO
Credential:
Phone: 570-455-9902