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NPI Code Detail

MEDICARE: CLOVER LEAF COUNSELING CENTER, LLC.

MEDICARE: CLOVER LEAF COUNSELING CENTER, LLC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
21041C0700XClinical Social Worker

General Provider Information

NPI Number : 1003539511
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLOVER LEAF COUNSELING CENTER, LLC.
Provider Business Mailing Address
First Line : 23 CLOVER LN
Second Line :
City : DANVILLE
State : PA
Zip : 17821-7960
Country : US
Telephone Number : 570-847-4623
Fax Number :
Provider Business Practice Location Address
First Line : 273 E 7TH ST
Second Line :
City : BLOOMSBURG
State : PA
Zip : 17815-2853
Country : US
Telephone Number : 570-507-7170
Fax Number :
Authorized Official
Title or Position : OWNER/ PROVIDER
Name : KARA DIANNE EBERLE- JONES
Credential : LCSW
Telephone Number : 570-847-4623
Provider Enumeration Date : 09/20/2022
Last Update Date : 10/20/2022

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