Healthcare Provider Details

I. General information

NPI: 1902719065
Provider Name (Legal Business Name): KEYSTONE COUNSELING & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 WEATHERBY WAY
MIFFLINTOWN PA
17059-8902
US

IV. Provider business mailing address

903 MAIN ST
PORT ROYAL PA
17082-9528
US

V. Phone/Fax

Practice location:
  • Phone: 717-348-3781
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: OLIVIA WISE
Title or Position: OWNER/THERAPIST
Credential: MS, LPC
Phone: 717-348-3781