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General NPI Number Information
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NPI Number | 1609251545
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Entity Type | Organization
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Legal Business Name | GREAT LAKES HOLISTIC COUNSELING
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Dates
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Enumeration Date | 07/21/2015
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Last Update Date | 07/21/2015
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Provider Practice Location Address
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Address Line | 4906 RICHMOND ST
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City | ERIE
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State | PA
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Zip | 16509-1978
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Country | US
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Telephone | 412-592-5834
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Fax |
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Provider Business Mailing Address
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Address Line | 4906 RICHMOND ST
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City | ERIE
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State | PA
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Zip | 16509-1978
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Country | US
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Telephone | 412-592-5834
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Fax |
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Authorized Official
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Title or Position | FOUNDER/OWNER
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Name | BRANDES LYNNE MONTGOMERY
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Credential | MS, NCC, LPC
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Telephone | 412-592-5834
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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 | PC007128
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License Number State | PA
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