Healthcare Provider Details

I. General information

NPI: 1881765527
Provider Name (Legal Business Name): MENTAL HEALTH ASSOCIATES OF NORTH CENTRAL PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 03/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 MAIN ST
TOWANDA PA
18848-1803
US

IV. Provider business mailing address

21 MAIN ST
TOWANDA PA
18848-1803
US

V. Phone/Fax

Practice location:
  • Phone: 570-265-2525
  • Fax: 570-265-1075
Mailing address:
  • Phone: 570-265-2525
  • Fax: 570-265-1075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number087021
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number087021
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number087022
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number087021
License Number StatePA
# 7
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number087021
License Number StatePA
# 8
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number087022
License Number StatePA
# 9
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number087021
License Number StatePA
# 10
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number087021
License Number StatePA
# 11
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number087021
License Number StatePA

VIII. Authorized Official

Name: MISS RENEE LYNN CASSELBURY
Title or Position: BUSINESS MANAGER
Credential:
Phone: 570-265-2525