Provider Demographics
NPI:1609941236
Name:CONNELLSVILLE COUNSELING CENTER, INC.
Entity Type:Organization
Organization Name:CONNELLSVILLE COUNSELING CENTER, INC.
Other - Org Name:THE STERN CENTER FOR DEVELOPMENTAL AND BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:724-626-9941
Mailing Address - Street 1:110 S ARCH ST
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-3515
Mailing Address - Country:US
Mailing Address - Phone:724-626-9941
Mailing Address - Fax:724-626-2785
Practice Address - Street 1:110 S ARCH ST
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-3515
Practice Address - Country:US
Practice Address - Phone:724-626-9941
Practice Address - Fax:724-626-2785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-070419L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015260180003Medicaid