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General NPI Number Information
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NPI Number | 1629512660
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Entity Type | Organization
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Legal Business Name | FAMILY THERAPY SERVICES
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Dates
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Enumeration Date | 12/09/2016
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Last Update Date | 12/09/2016
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Provider Practice Location Address
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Address Line | 307 MARKET ST
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City | JOHNSTOWN
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State | PA
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Zip | 15901-1701
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Country | US
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Telephone | 814-254-4351
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 273
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City | JOHNSTOWN
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State | PA
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Zip | 15907-0273
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CARLENE GIBSON
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Credential | LCSW
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Telephone | 814-254-4351
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904009477
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW018684
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License Number State | PA
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