Healthcare Provider Details
I. General information
NPI: 1366445082
Provider Name (Legal Business Name): NORTHEAST COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 05/27/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
750 E BROAD ST
HAZLETON PA
18201-6835
US
IV. Provider business mailing address
750 E BROAD ST
HAZLETON PA
18201-6835
US
V. Phone/Fax
- Phone: 570-455-6385
- Fax: 570-455-7064
- Phone: 570-455-6385
- Fax: 570-455-7064
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YM0800X |
| Taxonomy | Mental Health Counselor |
| License Number | |
| License Number State | PA |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103T00000X |
| Taxonomy | Psychologist |
| License Number | |
| License Number State | PA |
| # 3 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 104100000X |
| Taxonomy | Social Worker |
| License Number | |
| License Number State | PA |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 1007615710016 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 2 | |
| Identifier | 1007615710037 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 3 | |
| Identifier | 1007615710039 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 4 | |
| Identifier | 1007615710028 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 5 | |
| Identifier | 1007615710043 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 6 | |
| Identifier | 1007615710003 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 7 | |
| Identifier | 1007615710008 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 8 | |
| Identifier | 1007615710010 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 9 | |
| Identifier | 1007615710012 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 10 | |
| Identifier | 1007615710023 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 11 | |
| Identifier | 1007615710024 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 12 | |
| Identifier | 1007615710032 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 13 | |
| Identifier | 1007615710041 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 14 | |
| Identifier | 1007615710004 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 15 | |
| Identifier | 1007615710026 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 16 | |
| Identifier | 1007615710035 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 17 | |
| Identifier | 1007615710042 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
VIII. Authorized Official
Name: MS.
JOAN
KRAUSE
Title or Position: BOARD MEMBER
Credential:
Phone: 570-455-6385
