Healthcare Provider Details

I. General information

NPI: 1023074192
Provider Name (Legal Business Name): FOOTSTEPS PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 04/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 BLOOMFIELD ST SUITE 202
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 TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

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