Healthcare Provider Details

I. General information

NPI: 1639766157
Provider Name (Legal Business Name): JENNA L ST MARS M.ED, NCC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2020
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CIRCLE DR
ROSTRAVER TWP PA
15012-9680
US

IV. Provider business mailing address

500 CIRCLE DR
ROSTRAVER TWP PA
15012-9680
US

V. Phone/Fax

Practice location:
  • Phone: 724-417-2949
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC012323
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: