Provider Demographics
NPI:1235507492
Name:NORTHEAST COUNSELING SERVICES
Entity Type:Organization
Organization Name:NORTHEAST COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:
Authorized Official - First Name:FRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EMERSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-735-7590
Mailing Address - Street 1:121 S PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:NANTICOKE
Mailing Address - State:PA
Mailing Address - Zip Code:18634-2456
Mailing Address - Country:US
Mailing Address - Phone:570-735-7590
Mailing Address - Fax:
Practice Address - Street 1:1700 W 22ND ST
Practice Address - Street 2:
Practice Address - City:HAZLE TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18202-1535
Practice Address - Country:US
Practice Address - Phone:570-735-7590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1007615710065251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007615710065Medicaid