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General NPI Number Information
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NPI Number | 1093125023
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Entity Type | Organization
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Legal Business Name | ALLEGHENY MOUNTAIN COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 04/29/2014
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Last Update Date | 07/22/2014
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Provider Practice Location Address
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Address Line | 173 MAIN ST SUITE 200
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City | BROOKVILLE
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State | PA
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Zip | 15825-0815
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Country | US
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Telephone | 814-849-0019
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Fax | 814-849-0033
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Provider Business Mailing Address
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Address Line | 173 MAIN ST SUITE 200
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City | BROOKVILLE
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State | PA
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Zip | 15825-0815
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Country | US
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Telephone | 814-849-0019
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Fax | 814-849-0033
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | RAYMOND HANSEN
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Credential | L.P.C.
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Telephone | 814-849-0019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 001152
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 001152
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License Number State | PA
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