Healthcare Provider Details

I. General information

NPI: 1891816948
Provider Name (Legal Business Name): NORTHERN TIER COUNSELING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 03/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MAIN STREET
LAPORTE PA
18626
US

IV. Provider business mailing address

RR 1 BOX 137
TOWANDA PA
18848-9730
US

V. Phone/Fax

Practice location:
  • Phone: 570-265-0100
  • Fax:
Mailing address:
  • Phone: 570-265-0100
  • Fax: 570-265-6741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number201550
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. PAUL DENAULT
Title or Position: CEO
Credential:
Phone: 570-265-0100