=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730907312
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THREE PINES THERAPY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2024
-----------------------------------------------------
Last Update Date | 10/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4101 GROSCOST RD
-----------------------------------------------------
City | BEAVER FALLS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15010-9785
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 477-246-3006
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 396 4TH ST
-----------------------------------------------------
City | BEAVER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15009-2369
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-630-0647
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ANNA RASTATTER
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 724-630-0647
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------