Healthcare Provider Details

I. General information

NPI: 1215855440
Provider Name (Legal Business Name): CARLEE ROSETTA SHOWAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BEN AVE
MILL HALL PA
17751-1214
US

IV. Provider business mailing address

51 EISENHOWER CROSS RD
MILL HALL PA
17751-9320
US

V. Phone/Fax

Practice location:
  • Phone: 570-893-4900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH008565
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: