Healthcare Provider Details

I. General information

NPI: 1992118111
Provider Name (Legal Business Name): COUNSELING & WELLNESS CENTER OF SCRANTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 MOOSIC ST
SCRANTON PA
18505-4550
US

IV. Provider business mailing address

1021 MOOSIC ST
SCRANTON PA
18505-4550
US

V. Phone/Fax

Practice location:
  • Phone: 570-961-9355
  • Fax: 570-961-0782
Mailing address:
  • Phone: 570-961-9355
  • Fax: 570-961-0782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC002354
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier819491
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerFIRST PRIORITY HEALTH

VIII. Authorized Official

Name: MARY HELEN MORAN YATKO
Title or Position: OWNER
Credential: LPC
Phone: 570-961-9355