Healthcare Provider Details

I. General information

NPI: 1013007830
Provider Name (Legal Business Name): PAULA BRUST MA, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 06/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 ASH ST
SCRANTON PA
18510-1505
US

IV. Provider business mailing address

2200 ASH ST
SCRANTON PA
18510-1505
US

V. Phone/Fax

Practice location:
  • Phone: 570-969-2510
  • Fax: 570-383-0663
Mailing address:
  • Phone: 570-969-2510
  • Fax: 570-383-0663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number000482
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier22037
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerNBCC
# 2
Identifier000482
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerLICENSED PROFESSIONAL COU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: