Provider Demographics
NPI:1083669642
Name:COURTYARD COUNSELING CENTER
Entity Type:Organization
Organization Name:COURTYARD COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:G
Authorized Official - Last Name:BUTTO
Authorized Official - Suffix:
Authorized Official - Credentials:DSW ACSW LCSW
Authorized Official - Phone:570-743-2323
Mailing Address - Street 1:1372 N SUSQUEHANNA TRAIL
Mailing Address - Street 2:SUITE 330 7 COURTYARD OFFICES COURTYARD COUNSELING CENT
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870
Mailing Address - Country:US
Mailing Address - Phone:570-743-2323
Mailing Address - Fax:570-743-2343
Practice Address - Street 1:1372 N SUSQUEHANNA TRAIL
Practice Address - Street 2:SUITE 330 7 COURTYARD OFFICES COURTYARD COUNSELING CENT
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870
Practice Address - Country:US
Practice Address - Phone:570-743-2323
Practice Address - Fax:570-743-2343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000671101Y00000X
PAPS007127L103T00000X
PACW0120871041C0700X
PACW1020501041C0700X
PACW0135401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty