Healthcare Provider Details

I. General information

NPI: 1619639226
Provider Name (Legal Business Name): BEHAVIORAL HEALTH INTEGRATIVE CARE OF PA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2021
Last Update Date: 05/16/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2214 N ATHERTON ST STE 3-6
STATE COLLEGE PA
16803-1544
US

IV. Provider business mailing address

1170 S STATE ST
EPHRATA PA
17522-2601
US

V. Phone/Fax

Practice location:
  • Phone: 305-542-0687
  • Fax:
Mailing address:
  • Phone: 305-542-0687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. ALICIA SANTOS PIERCE
Title or Position: CORP. OPS MANAGER
Credential:
Phone: 561-473-9426