=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871444984
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MIA MARCEL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2026
-----------------------------------------------------
Last Update Date | 02/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 302 W CENTRAL AVE
-----------------------------------------------------
City | AVIS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17721-8901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-826-4052
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1269 QUARRY RD
-----------------------------------------------------
City | JERSEY SHORE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17740-8448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-295-8988
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------