Healthcare Provider Details

I. General information

NPI: 1518702067
Provider Name (Legal Business Name): PEDIATRIC COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 06/26/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 POTOMAC AVENUE, SUITE 200 SUITE 200
PITTSBURGH PA
15216
US

IV. Provider business mailing address

5426 CENTURY AVE
PITTSBURGH PA
15207-2332
US

V. Phone/Fax

Practice location:
  • Phone: 412-726-2267
  • Fax: 412-388-1880
Mailing address:
  • Phone: 412-726-2267
  • Fax: 412-388-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: STACEY MUNSIE
Title or Position: OWNER
Credential: LCSW
Phone: 412-726-2267