=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568425114
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARTHA A FURMAN LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 511 ALLEGHENY ST
-----------------------------------------------------
City | HOLLIDAYSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16648-2023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-693-6707
-----------------------------------------------------
Fax | 814-693-6707
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 511 ALLEGHENY ST. 2ND FL
-----------------------------------------------------
City | HOLLIDAYSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-693-6707
-----------------------------------------------------
Fax | 814-693-6707
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | PC 000369
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------