Provider Demographics
NPI:1033438585
Name:WESTERN PA BEHAVIORAL HEALTH RESOURCES LLC
Entity Type:Organization
Organization Name:WESTERN PA BEHAVIORAL HEALTH RESOURCES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:GEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-785-4346
Mailing Address - Street 1:129 SIMPSON RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BROWNSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15417-9689
Mailing Address - Country:US
Mailing Address - Phone:724-785-4346
Mailing Address - Fax:724-785-4347
Practice Address - Street 1:129 SIMPSON RD
Practice Address - Street 2:SUITE 107
Practice Address - City:BROWNSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15417-9689
Practice Address - Country:US
Practice Address - Phone:724-785-4346
Practice Address - Fax:724-785-4347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD423515261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health