Healthcare Provider Details

I. General information

NPI: 1144402413
Provider Name (Legal Business Name): ERIC T WELLMAN LPC, CRC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 WASHINGTON RD SUITE 202
MC MURRAY PA
15317-2534
US

IV. Provider business mailing address

RR 2 BOX 161
VALLEY GROVE WV
26060-8931
US

V. Phone/Fax

Practice location:
  • Phone: 724-941-6640
  • Fax: 724-941-6640
Mailing address:
  • Phone: 304-336-4282
  • Fax: 304-336-4282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC004735
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC004735
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: