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General NPI Number Information
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NPI Number | 1710538020
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Entity Type | Organization
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Legal Business Name | HAVEN OF TIOGA COUNTY
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Dates
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Enumeration Date | 09/27/2019
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Last Update Date | 09/27/2019
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Provider Practice Location Address
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Address Line | 48 EAST AVE
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City | WELLSBORO
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State | PA
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Zip | 16901-1714
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Country | US
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Telephone | 570-724-3549
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Fax | 570-724-1361
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Provider Business Mailing Address
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Address Line | 48 EAST AVE
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City | WELLSBORO
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State | PA
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Zip | 16901-1714
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Country | US
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Telephone | 570-724-3549
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Fax | 570-724-1361
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST
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Name | ELIZABETH A BLANTON
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Credential |
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Telephone | 570-634-3420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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