Healthcare Provider Details

I. General information

NPI: 1801708383
Provider Name (Legal Business Name): THERAPENN COUNSELING & BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

615 W. PENN ST
SHAMOKIN PA
17872
US

IV. Provider business mailing address

615 W. PENN ST
SHAMOKIN PA
17872
US

V. Phone/Fax

Practice location:
  • Phone: 570-500-9421
  • Fax:
Mailing address:
  • Phone: 570-500-9421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA A WAGNER
Title or Position: CEO/OWNER/COUNSELOR
Credential: MS, LPC
Phone: 570-500-9421