MEDICARE: PERSONAL POWER THERAPY

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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1568116879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERSONAL POWER THERAPY

Provider Business Mailing Address
First Line	:	6504 ROSEMOOR ST
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15217-3026
Country	:	US
Telephone Number	:	724-991-8351
Fax Number	:

Provider Business Practice Location Address
First Line	:	1141 S BRADDOCK AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15218-1250
Country	:	US
Telephone Number	:	724-991-8351
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL COUNSELOR
Name	:	CASEY CALLENDER
Credential	:	LPC
Telephone Number	:	724-991-8351

Provider Enumeration Date	:	02/05/2022
Last Update Date	:	02/05/2022

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Directions to “PERSONAL POWER THERAPY ” Practice Location

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