Healthcare Provider Details

I. General information

NPI: 1467743948
Provider Name (Legal Business Name): JOAN KAYLOR MSED NCC LICENSED PROFESSIONAL COUNSELOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2011
Last Update Date: 05/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 WATERDAM RD SUITE 260
MC MURRAY PA
15317-2573
US

IV. Provider business mailing address

157 WATERDAM RD SUITE 260
MC MURRAY PA
15317-2573
US

V. Phone/Fax

Practice location:
  • Phone: 724-942-5477
  • Fax: 724-942-5479
Mailing address:
  • Phone: 724-942-5477
  • Fax: 724-942-5479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC000222
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier102268135
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MRS. JOAN KAYLOR
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: MSED
Phone: 724-942-5477