Healthcare Provider Details

I. General information

NPI: 1801500111
Provider Name (Legal Business Name): PAUL FRANCIS TIERNEY III LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2023
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N WILKES BARRE BLVD STE 103
WILKES BARRE PA
18702-5240
US

IV. Provider business mailing address

100 N WILKES BARRE BLVD STE 103
WILKES BARRE PA
18702-5240
US

V. Phone/Fax

Practice location:
  • Phone: 570-846-2720
  • Fax: 570-518-7228
Mailing address:
  • Phone: 570-846-2720
  • Fax: 570-518-7228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC03385
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC020563
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: