Healthcare Provider Details

I. General information

NPI: 1881033876
Provider Name (Legal Business Name): CONCERN-PROFESSIONAL SERVICES FOR CHILDREN, YOUTH & FAMILIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2013
Last Update Date: 02/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DORSETT DR
MANSFIELD PA
16933-1517
US

IV. Provider business mailing address

1 W MAIN ST
FLEETWOOD PA
19522-1323
US

V. Phone/Fax

Practice location:
  • Phone: 570-724-7142
  • Fax:
Mailing address:
  • Phone: 610-944-0445
  • Fax: 610-944-8834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number221310
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number222440
License Number StatePA

VIII. Authorized Official

Name: MR. GORDON H. MAY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 610-944-0445