MEDICARE: MR. JOHN WILLIAM UBER PH.D.

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	PC000106	PA
2	103T00000X	Psychologist	PS016458	PA
3	103TC1900X	Counseling Psychologist	PS016458	PA

General Provider Information

NPI Number	:	1821153099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN WILLIAM UBER PH.D.

Provider Business Mailing Address
First Line	:	425 LIBERTY STREET
Second Line	:
City	:	GROVE CITY
State	:	PA
Zip	:	16127-2206
Country	:	US
Telephone Number	:	724-974-1513
Fax Number	:	724-458-5929

Provider Business Practice Location Address
First Line	:	425 LIBERTY STREET
Second Line	:
City	:	GROVE CITY
State	:	PA
Zip	:	16127-2206
Country	:	US
Telephone Number	:	724-974-1513
Fax Number	:	724-458-5929

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	12/20/2010

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