MEDICARE: REGIONAL COUNSELING CENTER, INC.

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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	422710	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053440958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGIONAL COUNSELING CENTER, INC.

Provider Business Mailing Address
First Line	:	815 GRANDVIEW RD
Second Line	:	P.O. BOX 886
City	:	OIL CITY
State	:	PA
Zip	:	16301-2077
Country	:	US
Telephone Number	:	814-676-5614
Fax Number	:	814-677-5760

Provider Business Practice Location Address
First Line	:	815 GRANDVIEW RD
Second Line	:
City	:	OIL CITY
State	:	PA
Zip	:	16301-2077
Country	:	US
Telephone Number	:	814-676-5614
Fax Number	:	814-677-5760

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. TAMMY TERESA AYLESWORTH
Credential	:	MA
Telephone Number	:	814-676-5614

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	08/22/2020

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