Provider Demographics
NPI:1376805127
Name:SERENITY COUNSELING
Entity Type:Organization
Organization Name:SERENITY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:MAKOS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:570-662-7788
Mailing Address - Street 1:3892 LAMBS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16933-9688
Mailing Address - Country:US
Mailing Address - Phone:570-662-7788
Mailing Address - Fax:570-662-7337
Practice Address - Street 1:3892 LAMBS CREEK RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:PA
Practice Address - Zip Code:16933-9688
Practice Address - Country:US
Practice Address - Phone:570-662-7788
Practice Address - Fax:570-662-7337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW014604251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA007166888Medicaid
799341Medicare PIN