Healthcare Provider Details

I. General information

NPI: 1639796550
Provider Name (Legal Business Name): JMC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 WASHINGTON RD STE 201
MC MURRAY PA
15317-2534
US

IV. Provider business mailing address

14 LINCOLN ST
COKEBURG PA
15324
US

V. Phone/Fax

Practice location:
  • Phone: 910-217-1211
  • Fax: 855-824-1872
Mailing address:
  • Phone: 910-217-1211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: JENNIFER MCCLARREN
Title or Position: OWNER
Credential: LPC
Phone: 910-217-1211