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General NPI Number Information
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NPI Number | 1497928154
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL ADVANCEMENTS OF DUBOIS
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Dates
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Enumeration Date | 04/02/2008
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Last Update Date | 04/02/2008
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Provider Practice Location Address
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Address Line | 105 WEST DUBOIS AVENUE JUNIATA PLACE SUITE B
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City | DUBOIS
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State | PA
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Zip | 15801
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Country | US
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Telephone | 814-375-7090
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Fax | 814-375-7940
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Provider Business Mailing Address
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Address Line | 105 WEST DUBOIS AVENUE JUNIATA PLACE SUITE B
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City | DUBOIS
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State | PA
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Zip | 15801
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Country | US
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Telephone | 814-375-7090
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Fax | 814-375-7940
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | SEAN P GARRED
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Credential | M., LPC, CRC
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Telephone | 814-375-7090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS007054L
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License Number State | PA
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