=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629492905
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELYSIA TARYN GROSCHWITZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2014
-----------------------------------------------------
Last Update Date | 01/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4963 STATE ROUTE 30 STE 204
-----------------------------------------------------
City | GREENSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15601-2343
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-244-6900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 31
-----------------------------------------------------
City | LUXOR
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15662-0031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-787-8344
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | PC011007
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------