Provider Demographics
NPI:1508172115
Name:VAN OSDOL, MARY ALLISON (LPC, MAC, MSCP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ALLISON
Last Name:VAN OSDOL
Suffix:
Gender:F
Credentials:LPC, MAC, MSCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12330 PERRY HWY
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8319
Mailing Address - Country:US
Mailing Address - Phone:724-462-9949
Mailing Address - Fax:724-462-9949
Practice Address - Street 1:12330 PERRY HWY
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8319
Practice Address - Country:US
Practice Address - Phone:724-462-9949
Practice Address - Fax:724-462-9949
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005158101YA0400X, 101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional