Healthcare Provider Details

I. General information

NPI: 1558598540
Provider Name (Legal Business Name): GLOBAL WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 06/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5504 PENN AVE
PITTSBURGH PA
15206
US

IV. Provider business mailing address

5504 PENN AVE
PITTSBURGH PA
15206
US

V. Phone/Fax

Practice location:
  • Phone: 412-670-2579
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberCW015492
License Number StatePA

VIII. Authorized Official

Name: MR. DAVID BURTON
Title or Position: SENIOR CLINICIAN
Credential:
Phone: 412-670-2579