Healthcare Provider Details

I. General information

NPI: 1508439613
Provider Name (Legal Business Name): KYLE GEIBIG BA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 WALNUT ST
JOHNSTOWN PA
15901-1625
US

IV. Provider business mailing address

119 WALNUT ST
JOHNSTOWN PA
15901-1625
US

V. Phone/Fax

Practice location:
  • Phone: 814-534-0745
  • Fax:
Mailing address:
  • Phone: 814-534-0745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC018163
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: