Healthcare Provider Details

I. General information

NPI: 1629434931
Provider Name (Legal Business Name): HOPE GROWS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 SHAFER RD
MOON TOWNSHIP PA
15108-1056
US

IV. Provider business mailing address

183 SHAFER RD
MOON TOWNSHIP PA
15108-1056
US

V. Phone/Fax

Practice location:
  • Phone: 412-369-4673
  • Fax: 412-369-4673
Mailing address:
  • Phone: 412-369-4673
  • Fax: 412-369-4673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC007396
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPC007396
License Number StatePA

VIII. Authorized Official

Name: MRS. LISA M STORY
Title or Position: EXECUTIVE DIRECTOR
Credential: LPC
Phone: 412-369-4673