Provider Demographics
NPI:1417275314
Name:INSIGHT PROFESSIONAL COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:INSIGHT PROFESSIONAL COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JONI
Authorized Official - Middle Name:ANDREA
Authorized Official - Last Name:SEFERSHAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:570-765-7085
Mailing Address - Street 1:8183 ROUTE 522
Mailing Address - Street 2:SUITE 10
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-9406
Mailing Address - Country:US
Mailing Address - Phone:570-765-7085
Mailing Address - Fax:570-765-7086
Practice Address - Street 1:8183 ROUTE 522
Practice Address - Street 2:SUITE 10
Practice Address - City:MIDDLEBURG
Practice Address - State:PA
Practice Address - Zip Code:17842-9406
Practice Address - Country:US
Practice Address - Phone:570-765-7085
Practice Address - Fax:570-765-7086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0156791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100984791 0003Medicaid