Provider Demographics
NPI:1235625716
Name:BEYOND COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:BEYOND COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:COSPER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:570-204-4028
Mailing Address - Street 1:16 SHERWOOD DRIVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-3086
Mailing Address - Country:US
Mailing Address - Phone:570-204-4028
Mailing Address - Fax:570-445-2214
Practice Address - Street 1:16 SHERWOOD DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-3086
Practice Address - Country:US
Practice Address - Phone:570-204-4028
Practice Address - Fax:570-445-2214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-08
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0189641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1035723800001Medicaid
PA0019468810006Medicaid