=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215210059
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIRST STEP COUNSELING, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2011
-----------------------------------------------------
Last Update Date | 09/27/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1611 PEACH ST SUITE 405
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16501-2109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-258-6414
-----------------------------------------------------
Fax | 814-725-0707
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1611 PEACH STREET SUITE 405
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-258-6414
-----------------------------------------------------
Fax | 814-725-0707
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE PROPRIETOR
-----------------------------------------------------
Name | JENNIFER YOUNG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-258-6414
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | PC005952
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------