Healthcare Provider Details

I. General information

NPI: 1609243898
Provider Name (Legal Business Name): THAXTON HOLISTIC WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 S MAIN AVE
SCRANTON PA
18504-2545
US

IV. Provider business mailing address

228 S MAIN AVE
SCRANTON PA
18504-2545
US

V. Phone/Fax

Practice location:
  • Phone: 570-904-7363
  • Fax: 570-227-1591
Mailing address:
  • Phone: 570-904-7363
  • Fax: 570-348-4079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC008211
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. SARA LYNNE THAXTON
Title or Position: OWNER
Credential: PHD LPC
Phone: 570-904-7363