Healthcare Provider Details

I. General information

NPI: 1184553612
Provider Name (Legal Business Name): CHANNEL OF PEACE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 N MICHAEL ST STE L3
SAINT MARYS PA
15857-1171
US

IV. Provider business mailing address

208 MARTIN RD
SAINT MARYS PA
15857-2124
US

V. Phone/Fax

Practice location:
  • Phone: 814-225-8660
  • Fax:
Mailing address:
  • Phone: 814-225-8660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: JUSTIN LEE BAUER
Title or Position: OWNER
Credential: LCSW
Phone: 814-335-0873