MEDICARE: KING-THOMAS COUNSELING 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
1	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1760266811
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KING-THOMAS COUNSELING LLC

Provider Business Mailing Address
First Line	:	665 PHILADELPHIA ST STE 104A
Second Line	:
City	:	INDIANA
State	:	PA
Zip	:	15701-3941
Country	:	US
Telephone Number	:	724-388-5052
Fax Number	:

Provider Business Practice Location Address
First Line	:	665 PHILADELPHIA ST STE 104A
Second Line	:
City	:	INDIANA
State	:	PA
Zip	:	15701-3941
Country	:	US
Telephone Number	:	724-388-5052
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KATRINA L KING-THOMAS
Credential	:	M.S, LPC
Telephone Number	:	724-388-5052

Provider Enumeration Date	:	08/21/2023
Last Update Date	:	08/22/2023

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