Healthcare Provider Details

I. General information

NPI: 1255471249
Provider Name (Legal Business Name): NORTHEAST COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 S PROSPECT ST
NANTICOKE PA
18634-2456
US

IV. Provider business mailing address

750 E BROAD ST
HAZLETON PA
18201-6835
US

V. Phone/Fax

Practice location:
  • Phone: 570-735-7590
  • Fax:
Mailing address:
  • Phone: 570-455-6385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number1007615710065
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number1007615710065
License Number StatePA

VIII. Authorized Official

Name: MR. FRAN EMERSHAW
Title or Position: EXEC DIRECTOR
Credential:
Phone: 570-455-6385