Healthcare Provider Details

I. General information

NPI: 1841040631
Provider Name (Legal Business Name): CHRISTOPHER L STOUGH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 LONG RUN RD STE 104
MCKEESPORT PA
15132-7424
US

IV. Provider business mailing address

633 LONG RUN RD STE 104
MCKEESPORT PA
15132-7424
US

V. Phone/Fax

Practice location:
  • Phone: 412-385-7129
  • Fax: 412-896-1272
Mailing address:
  • Phone: 412-385-7129
  • Fax: 412-896-1272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
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: CHRISTOPHER L STOUGH
Title or Position: OWNER
Credential: LCSW
Phone: 412-385-7129