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General NPI Number Information
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NPI Number | 1336320936
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Entity Type | Organization
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Legal Business Name | MARKET STREET COUNSELING
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Dates
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Enumeration Date | 11/25/2007
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Last Update Date | 11/25/2007
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Provider Practice Location Address
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Address Line | 424 1/2 MARKET ST
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City | LEWISBURG
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State | PA
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Zip | 17837-1495
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Country | US
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Telephone | 570-523-1212
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Fax |
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Provider Business Mailing Address
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Address Line | 424 1/2 MARKET ST
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City | LEWISBURG
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State | PA
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Zip | 17837-1495
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Country | US
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Telephone | 570-523-1212
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST
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Name | PATRICIA H KEELER
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Credential | LSW
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Telephone | 570-523-1212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 011675-L
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License Number State | PA
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