Healthcare Provider Details

I. General information

NPI: 1649202094
Provider Name (Legal Business Name): RURAL MENTAL HEALTH ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 CENTRAL AVE 3RD FLOOR
OIL CITY PA
16301-2733
US

IV. Provider business mailing address

19 CENTRAL AVE 3RD FLOOR
OIL CITY PA
16301-2733
US

V. Phone/Fax

Practice location:
  • Phone: 814-678-6900
  • Fax: 814-678-6902
Mailing address:
  • Phone: 814-678-6900
  • Fax: 814-678-6902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC003785
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC000646
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS005971L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS005854L
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW125709
License Number StatePA
# 6
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW013252
License Number StatePA
# 7
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW014422
License Number StatePA
# 8
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW014657
License Number StatePA

VIII. Authorized Official

Name: SUSAN BOYER DRELICK
Title or Position: PRESIDENT
Credential: MA
Phone: 814-678-6900