Healthcare Provider Details

I. General information

NPI: 1841289733
Provider Name (Legal Business Name): CEN CLEAR CHILD SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 PHILIPSBURG BIGLER HWY
PHILIPSBURG PA
16866-8112
US

IV. Provider business mailing address

PO BOX 319 50 BIGLER ROAD
BIGLER PA
16825-0319
US

V. Phone/Fax

Practice location:
  • Phone: 814-342-5678
  • Fax: 814-342-2755
Mailing address:
  • Phone: 814-342-5678
  • Fax: 814-342-2755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number406200
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number406200
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number406200
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number406200
License Number StatePA
# 7
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 9
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number406200
License Number StatePA

VIII. Authorized Official

Name: MRS. PAULINE RAAB
Title or Position: CEO
Credential:
Phone: 814-342-5678