Healthcare Provider Details

I. General information

NPI: 1669676870
Provider Name (Legal Business Name): MON YOUGH COMMUNITY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 SHAW AVE
MCKEESPORT PA
15132-2918
US

IV. Provider business mailing address

335 SHAW AVE
MCKEESPORT PA
15132-2918
US

V. Phone/Fax

Practice location:
  • Phone: 412-675-8533
  • Fax: 412-675-8920
Mailing address:
  • Phone: 412-675-8533
  • Fax: 412-675-8920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier100000980
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier648059
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK BLUE SHIELD

VIII. Authorized Official

Name: MRS. CATHERINE R CONROY
Title or Position: MANAGED CARE COORDINATOR
Credential:
Phone: 412-675-8533