Provider Demographics
NPI:1235398801
Name:GAMBLING TREATMENT ASSOCIATES, INC.
Entity Type:Organization
Organization Name:GAMBLING TREATMENT ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:1800-955-7938
Mailing Address - Street 1:RR 1 BOX 61H1
Mailing Address - Street 2:
Mailing Address - City:TIONESTA
Mailing Address - State:PA
Mailing Address - Zip Code:16353-9610
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:821 MAIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15215-2209
Practice Address - Country:US
Practice Address - Phone:800-955-7938
Practice Address - Fax:141-278-2680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008756L103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty