Healthcare Provider Details

I. General information

NPI: 1992839492
Provider Name (Legal Business Name): NORTHERN TIER COUNSELING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 STATE ST
TOWANDA PA
18848-8795
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 TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number226990
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier000753722
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK PROV#-PSYCHIATRY

VIII. Authorized Official

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