Provider Demographics
NPI:1275654956
Name:LUZERNE WYOMING CO MHC#1
Entity Type:Organization
Organization Name:LUZERNE WYOMING CO MHC#1
Other - Org Name:CHOICES A DIVISION OF BEHAVIORAL HEALTH SERVICES OF WYOMING VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF ALL CHOICES PROGRAMS
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:EDITH
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW,ACSW,LCSW,CCDP
Authorized Official - Phone:570-552-3700
Mailing Address - Street 1:RR 1 BOX 282C
Mailing Address - Street 2:
Mailing Address - City:WAPWALLOPEN
Mailing Address - State:PA
Mailing Address - Zip Code:18660-9771
Mailing Address - Country:US
Mailing Address - Phone:570-417-2830
Mailing Address - Fax:
Practice Address - Street 1:562 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-3721
Practice Address - Country:US
Practice Address - Phone:570-552-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW014765261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder