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General NPI Number Information
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NPI Number | 1609941236
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Entity Type | Organization
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Legal Business Name | CONNELLSVILLE COUNSELING CENTER, INC.
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 02/17/2012
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Provider Practice Location Address
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Address Line | 110 S ARCH ST
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City | CONNELLSVILLE
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State | PA
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Zip | 15425-3515
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Country | US
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Telephone | 724-626-9941
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Fax | 724-626-2785
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Provider Business Mailing Address
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Address Line | 110 S ARCH ST
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City | CONNELLSVILLE
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State | PA
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Zip | 15425-3515
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Country | US
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Telephone | 724-626-9941
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Fax | 724-626-2785
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Authorized Official
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Title or Position | COO
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Name | MR. CHRIS STERN
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Credential | ESQ.
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Telephone | 724-626-9941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD-070419L
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License Number State | PA
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