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General NPI Number Information
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NPI Number | 1063178606
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Entity Type | Organization
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Legal Business Name | COMMON SENSE LIFESTYLE LLC
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Dates
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Enumeration Date | 11/09/2021
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Last Update Date | 11/09/2021
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Provider Practice Location Address
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Address Line | 317 LUZERNE AVE
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City | WEST PITTSTON
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State | PA
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Zip | 18643-2233
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Country | US
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Telephone | 570-899-6837
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Fax | 570-654-7414
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Provider Business Mailing Address
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Address Line | 166 JOHNSON ST FL 2
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City | PITTSTON
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State | PA
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Zip | 18640-1034
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Country | US
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Telephone | 570-899-6837
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Fax | 570-654-7414
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Authorized Official
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Title or Position | OWNER
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Name | MR. ROBERT MATTHEW ROSS
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Credential | MS, NCC, LPC
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Telephone | 570-899-6837
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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