Provider Demographics
NPI:1497928154
Name:BEHAVIORAL ADVANCEMENTS OF DUBOIS
Entity Type:Organization
Organization Name:BEHAVIORAL ADVANCEMENTS OF DUBOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:GARRED
Authorized Official - Suffix:
Authorized Official - Credentials:M, LPC, CRC
Authorized Official - Phone:814-375-7090
Mailing Address - Street 1:105 WEST DUBOIS AVENUE
Mailing Address - Street 2:JUNIATA PLACE SUITE B
Mailing Address - City:DUBOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801
Mailing Address - Country:US
Mailing Address - Phone:814-375-7090
Mailing Address - Fax:814-375-7940
Practice Address - Street 1:105 WEST DUBOIS AVENUE
Practice Address - Street 2:JUNIATA PLACE SUITE B
Practice Address - City:DUBOIS
Practice Address - State:PA
Practice Address - Zip Code:15801
Practice Address - Country:US
Practice Address - Phone:814-375-7090
Practice Address - Fax:814-375-7940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007054L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017312240003Medicaid
PA489548OtherHIGHMARK BLUE CROSS
PAVC0634OtherCOMMUNITY CARE BEHAVIORAL