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General NPI Number Information
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NPI Number | 1669804571
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Entity Type | Organization
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Legal Business Name | FOOTSTEPS PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 08/01/2013
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Last Update Date | 04/27/2017
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Provider Practice Location Address
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Address Line | 334 BLOOMFIELD ST SUITE 104
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City | JOHNSTOWN
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State | PA
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Zip | 15904-3268
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Country | US
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Telephone | 814-266-5238
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Fax |
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Provider Business Mailing Address
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Address Line | 334 BLOOMFIELD ST SUITE 204
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City | JOHNSTOWN
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State | PA
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Zip | 15904-3268
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Country | US
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Telephone | 814-266-5238
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TAMMY K HASLETT
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Credential | PH.D.
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Telephone | 814-266-5238
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS008994L
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License Number State | PA
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