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General NPI Number Information
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NPI Number | 1578104345
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Entity Type | Individual
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Provider Name | ETHAN R MESSENGER
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Gender | Male
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Dates
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Enumeration Date | 10/03/2019
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Last Update Date | 12/03/2020
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Provider Practice Location Address
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Address Line | 20 E BURD ST STE 1
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City | SHIPPENSBURG
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State | PA
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Zip | 17257-1328
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Country | US
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Telephone | 717-477-2556
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Fax |
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Provider Business Mailing Address
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Address Line | 1260 2ND AVE
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City | CHAMBERSBURG
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State | PA
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Zip | 17202-9723
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Country | US
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Telephone | 717-448-6780
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PC011433
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC011433
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License Number State | PA
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