Provider Demographics
NPI:1235309949
Name:VERNAM COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:VERNAM COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC AND OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODY
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:VERNAM
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:724-458-4990
Mailing Address - Street 1:107 BRECKENRIDGE STREET
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-1025
Mailing Address - Country:US
Mailing Address - Phone:724-458-4990
Mailing Address - Fax:855-775-0514
Practice Address - Street 1:107 BRECKENRIDGE STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-1025
Practice Address - Country:US
Practice Address - Phone:724-458-4990
Practice Address - Fax:855-775-0514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004344101Y00000X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102297262Medicaid
PA1973158OtherHIGHMARK BCBS PIN