Healthcare Provider Details

I. General information

NPI: 1215292537
Provider Name (Legal Business Name): MARY LUCILLE TROY MS, NCC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY DOYLE TROY MS, NCC, LPC

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 07/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 W OLIVE ST
SCRANTON PA
18508-2572
US

IV. Provider business mailing address

425 JESSUP ST
DUNMORE PA
18512-2010
US

V. Phone/Fax

Practice location:
  • Phone: 570-498-5593
  • Fax: 570-969-0449
Mailing address:
  • Phone: 570-969-0449
  • Fax: 570-969-0449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC002617
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: