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General NPI Number Information
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NPI Number | 1215592209
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Entity Type | Organization
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Legal Business Name | MVCOUNSELING LLC
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Dates
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Enumeration Date | 05/06/2019
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Last Update Date | 06/08/2021
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Provider Practice Location Address
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Address Line | 421 S STATE ST
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City | CLARKS SUMMIT
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State | PA
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Zip | 18411-1684
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Country | US
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Telephone | 570-479-3835
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Fax |
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Provider Business Mailing Address
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Address Line | 209 ASHMORE AVE
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City | CLARKS SUMMIT
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State | PA
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Zip | 18411-1562
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Country | US
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Telephone | 570-877-3140
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | MITCHELL L VALBURG
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Credential | M.S., L.P.C.
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Telephone | 570-877-3140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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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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