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General NPI Number Information
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NPI Number | 1205565959
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Entity Type | Organization
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Legal Business Name | 412 THERAPY CO
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Dates
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Enumeration Date | 06/08/2022
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Last Update Date | 06/08/2022
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Provider Practice Location Address
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Address Line | 927 BROOKLINE BLVD
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City | PITTSBURGH
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State | PA
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Zip | 15226-2181
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Country | US
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Telephone | 724-747-3854
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Fax |
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Provider Business Mailing Address
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Address Line | 516 HIGHFIELD AVE
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City | CANONSBURG
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State | PA
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Zip | 15317-1245
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Country | US
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Telephone | 724-747-3854
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | LAUREL WASSON
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Credential | LPC, PMHC
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Telephone | 724-747-3854
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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