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General NPI Number Information
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NPI Number | 1558482992
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Entity Type | Organization
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Legal Business Name | CLEARFIELD-JEFFERSON CMHC
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 501 E MARKET ST
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City | CLEARFIELD
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State | PA
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Zip | 16830-2468
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Country | US
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Telephone | 814-371-1100
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Fax | 814-375-0120
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Provider Business Mailing Address
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Address Line | 501 E MARKET ST
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City | CLEARFIELD
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State | PA
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Zip | 16830-2468
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Country | US
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Telephone | 814-371-1100
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Fax | 814-375-0120
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Authorized Official
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Title or Position | BILLING SUPERVISOR
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Name | KAREN H FORSHA
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Credential | B.S. EDUCATION
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Telephone | 814-371-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | 407300
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License Number State | PA
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