Healthcare Provider Details

I. General information

NPI: 1679799126
Provider Name (Legal Business Name): CARBON LEHIGH INTERMEDIATE UNIT #21
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 STATE RD
LEHIGHTON PA
18235-2857
US

IV. Provider business mailing address

4210 E INDEPENDENCE DR
SCHNECKSVILLE PA
18078-2580
US

V. Phone/Fax

Practice location:
  • Phone: 610-769-1160
  • Fax: 610-769-1205
Mailing address:
  • Phone: 610-769-4111
  • Fax: 610-769-1250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number216190
License Number StatePA

VIII. Authorized Official

Name: DR. GREG KOONS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 610-769-4111