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General NPI Number Information
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NPI Number | 1053757518
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Entity Type | Organization
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Legal Business Name | FOOTSTEPS PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 05/10/2013
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Last Update Date | 05/10/2013
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Provider Practice Location Address
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Address Line | 334 BLOOMFIELD ST SUITE 204
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City | JOHNSTOWN
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State | PA
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Zip | 15904-3268
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Country | US
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Telephone | 814-266-5238
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Fax | 814-266-1762
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Provider Business Mailing Address
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Address Line | 334 BLOOMFIELD ST SUITE 204
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City | JOHNSTOWN
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State | PA
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Zip | 15904-3268
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Country | US
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Telephone | 814-266-5238
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Fax | 814-266-1762
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Authorized Official
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Title or Position | OWNER
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Name | DR. TAMMY K HASLETT
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Credential | PH.D.
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Telephone | 814-266-5238
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW123369
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC005218
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License Number State | PA
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