=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831360528
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CEN CLEAR CHILD SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2008
-----------------------------------------------------
Last Update Date | 12/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 580 OLD ROUTE 322
-----------------------------------------------------
City | PHILIPSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16866-8004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-342-5678
-----------------------------------------------------
Fax | 814-342-2755
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50 BIGLER ROAD
-----------------------------------------------------
City | WOODLAND
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16881-0204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-342-5678
-----------------------------------------------------
Fax | 814-342-2755
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MARK WENDEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 814-342-5678
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 406200
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------