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General NPI Number Information
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NPI Number | 1548778202
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Entity Type | Organization
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Legal Business Name | WATERSHED COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 01/16/2018
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 143 W. MAIN ST. SUITE 110
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City | NORTH EAST
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State | PA
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Zip | 16428-1333
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Country | US
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Telephone | 814-347-5018
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Fax | 814-347-5186
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Provider Business Mailing Address
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Address Line | 143 WEST MAIN STREET SUITE 110
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City | NORTH EAST
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State | PA
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Zip | 16428-1333
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Country | US
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Telephone | 814-347-5018
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Fax | 814-347-5186
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | ANGELA FRANK
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Credential | LPC, NCC, CAADC
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Telephone | 814-347-5018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | PC010131
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | PC010131
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | PC010131
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License Number State | PA
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