MEDICARE: CONSILIUM BEHAVIORAL HEALTH

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1801471727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONSILIUM BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	904 SHERMAN AVE
Second Line	:
City	:	IRWIN
State	:	PA
Zip	:	15642-3742
Country	:	US
Telephone Number	:	724-205-2987
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 BRUSH CREEK RD
Second Line	:
City	:	IRWIN
State	:	PA
Zip	:	15642-9504
Country	:	US
Telephone Number	:	724-205-2987
Fax Number	:

Authorized Official
Title or Position	:	CO-FOUNDER
Name	:	MRS. COURTNEY KIRKPATRICK
Credential	:
Telephone Number	:	724-205-2987

Provider Enumeration Date	:	03/11/2021
Last Update Date	:	03/11/2021

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