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General NPI Number Information
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NPI Number | 1366109928
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Entity Type | Organization
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Legal Business Name | CONNECTIONS RELATIONAL THERAPY LLC
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Dates
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Enumeration Date | 11/18/2021
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Last Update Date | 11/18/2021
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Provider Practice Location Address
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Address Line | 8 W SNYDER ST STE 2
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City | SELINSGROVE
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State | PA
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Zip | 17870-1504
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Country | US
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Telephone | 570-259-4388
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Fax |
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Provider Business Mailing Address
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Address Line | 194 STACEY LN
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City | MIDDLEBURG
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State | PA
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Zip | 17842-8916
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Country | US
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Telephone | 570-259-4388
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TARA DIVELY
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Credential |
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Telephone | 570-259-4388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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