Healthcare Provider Details

I. General information

NPI: 1346027380
Provider Name (Legal Business Name): CONCERN-PROFESSIONAL SERVICES FOR CHILDREN, YOUTH & FAMILIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7406 ROUTE 487
MILDRED PA
18632-9031
US

IV. Provider business mailing address

1 W MAIN ST
FLEETWOOD PA
19522-1323
US

V. Phone/Fax

Practice location:
  • Phone: 570-340-0655
  • Fax:
Mailing address:
  • Phone: 484-578-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GORDON H MAY
Title or Position: PRESIDENT/CEO
Credential:
Phone: 484-578-9600