Healthcare Provider Details

I. General information

NPI: 1205565959
Provider Name (Legal Business Name): 412 THERAPY CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 BROOKLINE BLVD
PITTSBURGH PA
15226-2181
US

IV. Provider business mailing address

516 HIGHFIELD AVE
CANONSBURG PA
15317-1245
US

V. Phone/Fax

Practice location:
  • Phone: 724-747-3854
  • Fax:
Mailing address:
  • Phone: 724-747-3854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LAUREL WASSON
Title or Position: OWNER/THERAPIST
Credential: LPC, PMHC
Phone: 724-747-3854