Healthcare Provider Details

I. General information

NPI: 1164037982
Provider Name (Legal Business Name): K NADERMANN COUNSELING AND SUPERVISION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E BEAVER AVE STE 3
STATE COLLEGE PA
16801-4969
US

IV. Provider business mailing address

223 GWENEDD LN
PLEASANT GAP PA
16823-9614
US

V. Phone/Fax

Practice location:
  • Phone: 814-201-7601
  • Fax:
Mailing address:
  • Phone: 508-446-2309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

VIII. Authorized Official

Name: KRISTEN NADERMANN
Title or Position: OWNER, LPC
Credential: PHD, LPC
Phone: 508-446-2309