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General NPI Number Information
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NPI Number | 1881400455
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Entity Type | Individual
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Provider Name | SHWETHA GOTTUMUKKALA
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Gender |
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 201 W 11TH ST
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City | ERIE
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State | PA
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Zip | 16501-1701
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Country | US
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Telephone | 833-487-5769
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Fax |
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Provider Business Mailing Address
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Address Line | 1027 AMBER CT APT 8
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City | ERIE
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State | PA
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Zip | 16502-2959
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Country | US
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Telephone | 470-487-3114
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | APC000674
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License Number State | PA
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