MEDICARE: PENNSYLVANIA COUNSELING SERVICES 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)
2	101Y00000X	Counselor

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	:	1669474979
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENNSYLVANIA COUNSELING SERVICES INC.

Provider Business Mailing Address
First Line	:	200 N 7TH ST
Second Line	:
City	:	LEBANON
State	:	PA
Zip	:	17046-5040
Country	:	US
Telephone Number	:	717-273-1710
Fax Number	:	717-273-1416

Provider Business Practice Location Address
First Line	:	200 N 7TH ST
Second Line	:
City	:	LEBANON
State	:	PA
Zip	:	17046-5040
Country	:	US
Telephone Number	:	717-273-1710
Fax Number	:	717-273-1416

Authorized Official
Title or Position	:	DIRECTOR OF MANAGED CARE
Name	:	DENA BREWER
Credential	:	AA
Telephone Number	:	717-273-1710

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	06/09/2008

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