Healthcare Provider Details

I. General information

NPI: 1346267374
Provider Name (Legal Business Name): NORTHERN TIER COUNSELING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24727 ROUTE 6 STE 2
TOWANDA PA
18848-8257
US

IV. Provider business mailing address

24727 ROUTE 6 STE 2
TOWANDA PA
18848-8257
US

V. Phone/Fax

Practice location:
  • Phone: 570-265-0100
  • Fax: 570-265-6741
Mailing address:
  • Phone: 570-265-0100
  • Fax: 570-265-6741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. PAUL DENAULT
Title or Position: CEO
Credential:
Phone: 570-265-0100