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General NPI Number Information
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NPI Number | 1235398801
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Entity Type | Organization
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Legal Business Name | GAMBLING TREATMENT ASSOCIATES, INC.
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 06/09/2008
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Provider Practice Location Address
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Address Line | 821 MAIN ST 2ND FLOOR
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City | PITTSBURGH
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State | PA
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Zip | 15215-2209
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Country | US
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Telephone | 800-955-7938
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Fax | 141-278-2680
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Provider Business Mailing Address
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Address Line | RR 1 BOX 61H1
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City | TIONESTA
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State | PA
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Zip | 16353-9610
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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 | CHIEF EXECUTIVE OFFICER
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Name | DR. WAYNE ANTHONY HOOVER
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Credential | PHD
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Telephone | 18009557938
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PS008756L
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License Number State | PA
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