Healthcare Provider Details

I. General information

NPI: 1245099639
Provider Name (Legal Business Name): CLINICAL COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

569 SNOWHILL RD
NORTHAMPTON PA
18067-9159
US

IV. Provider business mailing address

3940 EAGLE CIR
SLATINGTON PA
18080-3837
US

V. Phone/Fax

Practice location:
  • Phone: 610-577-5788
  • Fax:
Mailing address:
  • Phone: 610-577-5788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LARRY SCHEW
Title or Position: PRESIDENT
Credential: MSW
Phone: 610-577-5788