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General NPI Number Information
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NPI Number | 1194030726
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Entity Type | Organization
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Legal Business Name | ENDLESS MOUNTAINS COUNSELING ASSOCIATES
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Dates
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Enumeration Date | 08/06/2010
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Last Update Date | 08/06/2010
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Provider Practice Location Address
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Address Line | 27241 STATE ROUTE 267
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City | FRIENDSVILLE
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State | PA
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Zip | 18818-8640
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Country | US
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Telephone | 570-553-2078
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Fax |
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Provider Business Mailing Address
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Address Line | 27241 STATE ROUTE 267
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City | FRIENDSVILLE
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State | PA
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Zip | 18818-8640
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | M.S.
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Name | MR. ROGER SMOTHERS
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Credential |
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Telephone | 570-553-2078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS004970L
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License Number State | PA
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