Healthcare Provider Details

I. General information

NPI: 1376845479
Provider Name (Legal Business Name): CONCERN-PROFESSIONAL SERVICES FOR CHILDREN, YOUTH & FAMILIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2010
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 MAIN ST
TOWANDA PA
18848-1805
US

IV. Provider business mailing address

1 W MAIN ST
FLEETWOOD PA
19522-1323
US

V. Phone/Fax

Practice location:
  • Phone: 570-268-3073
  • Fax:
Mailing address:
  • Phone: 610-944-0445
  • Fax: 610-944-8834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number222440
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number218440
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number218440
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number225490
License Number StatePA

VIII. Authorized Official

Name: MR. GORDON H. MAY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 610-944-0445