Healthcare Provider Details

I. General information

NPI: 1730670274
Provider Name (Legal Business Name): HAPPY VALLEY COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1362 S ATHERTON ST
STATE COLLEGE PA
16801-6203
US

IV. Provider business mailing address

1510 CHAUMONT AVE
STATE COLLEGE PA
16801-8800
US

V. Phone/Fax

Practice location:
  • Phone: 814-404-7700
  • Fax: 814-308-9099
Mailing address:
  • Phone: 814-404-5686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW015757
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MS. MARIANNE LINDAU DAUGHERTY
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 814-404-5686