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General NPI Number Information
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NPI Number | 1427803345
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Entity Type | Organization
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Legal Business Name | ACTIVE THERAPY INSTITUTE, LLC
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Dates
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Enumeration Date | 04/23/2024
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Last Update Date | 04/23/2024
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Provider Practice Location Address
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Address Line | 74 E FORREST AVE
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City | SHREWSBURY
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State | PA
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Zip | 17361-1427
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Country | US
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Telephone | 717-814-9016
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Fax |
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Provider Business Mailing Address
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Address Line | 18B CHURCH ST
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City | STEWARTSTOWN
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State | PA
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Zip | 17363-4015
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Country | US
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Telephone | 717-814-9016
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Fax |
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Authorized Official
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Title or Position | OWNER, PROFESSIONAL COUNSELOR
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Name | MR. TYLER JOHN SCHUHLY
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Credential | M.S., LPC, NCC
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Telephone | 717-814-1506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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