Healthcare Provider Details

I. General information

NPI: 1053757518
Provider Name (Legal Business Name): FOOTSTEPS PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 05/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 BLOOMFIELD ST SUITE 204
JOHNSTOWN PA
15904-3268
US

IV. Provider business mailing address

334 BLOOMFIELD ST SUITE 204
JOHNSTOWN PA
15904-3268
US

V. Phone/Fax

Practice location:
  • Phone: 814-266-5238
  • Fax: 814-266-1762
Mailing address:
  • Phone: 814-266-5238
  • Fax: 814-266-1762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC005218
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW123369
License Number StatePA

VIII. Authorized Official

Name: DR. TAMMY K HASLETT
Title or Position: OWNER
Credential: PH.D.
Phone: 814-266-5238