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General NPI Number Information
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NPI Number | 1598041832
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Entity Type | Individual
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Provider Name | JENNIFER LYDIA FLACK M.ED, NCC, LPC
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Gender | Female
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Dates
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Enumeration Date | 11/01/2011
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Last Update Date | 11/01/2011
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Provider Practice Location Address
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Address Line | 209 S MAPLE AVE
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City | GREENSBURG
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State | PA
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Zip | 15601-3216
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Country | US
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Telephone | 724-420-5038
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Fax | 724-420-5863
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Provider Business Mailing Address
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Address Line | 7 2ND AVE
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City | SCOTTDALE
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State | PA
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Zip | 15683-2102
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Country | US
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Telephone | 724-953-9733
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC005970
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number |
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License Number State | PA
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