Healthcare Provider Details

I. General information

NPI: 1871150722
Provider Name (Legal Business Name): JONATHAN MICHAEL REVELEY-COHEN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 5TH ST STE 203
HUNTINGDON PA
16652-1549
US

IV. Provider business mailing address

201 5TH ST STE 203
HUNTINGDON PA
16652-1549
US

V. Phone/Fax

Practice location:
  • Phone: 814-251-1696
  • Fax:
Mailing address:
  • Phone: 814-251-1696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPC008839
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC008839
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC008839
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: