Provider Demographics
NPI:1366445082
Name:NORTHEAST COUNSELING SERVICES
Entity Type:Organization
Organization Name:NORTHEAST COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-455-6385
Mailing Address - Street 1:750 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-6835
Mailing Address - Country:US
Mailing Address - Phone:570-455-6385
Mailing Address - Fax:570-455-7064
Practice Address - Street 1:750 E BROAD ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-6835
Practice Address - Country:US
Practice Address - Phone:570-455-6385
Practice Address - Fax:570-455-7064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YM0800X, 103T00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007615710016Medicaid
PA1007615710037Medicaid
PA1007615710039Medicaid
PA1007615710028Medicaid
PA1007615710043Medicaid
PA1007615710003Medicaid
PA1007615710008Medicaid
PA1007615710010Medicaid
PA1007615710012Medicaid
PA1007615710023Medicaid
PA1007615710024Medicaid
PA1007615710032Medicaid
PA1007615710041Medicaid
PA1007615710004Medicaid
PA1007615710026Medicaid
PA1007615710035Medicaid
PA1007615710042Medicaid
PA1007615710028Medicaid