=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306351176
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAULA JEAN THALMAN LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2017
-----------------------------------------------------
Last Update Date | 09/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2400 ANSYS DR STE 102
-----------------------------------------------------
City | CANONSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15317-0403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-678-5899
-----------------------------------------------------
Fax | --
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2077 BREEZEWOOD DR
-----------------------------------------------------
City | CANONSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15317-6502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-678-5899
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | PC009853
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------