Provider Demographics
NPI:1629439856
Name:HOPE CENTER FOR COUNSELING AND MENTAL WELLNESS
Entity Type:Organization
Organization Name:HOPE CENTER FOR COUNSELING AND MENTAL WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAMI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HRISAK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:814-227-2232
Mailing Address - Street 1:9664 ROUTE 322
Mailing Address - Street 2:
Mailing Address - City:SHIPPENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16254-8734
Mailing Address - Country:US
Mailing Address - Phone:814-227-2232
Mailing Address - Fax:814-227-2401
Practice Address - Street 1:9664 ROUTE 322
Practice Address - Street 2:
Practice Address - City:SHIPPENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16254-8734
Practice Address - Country:US
Practice Address - Phone:814-227-2232
Practice Address - Fax:814-227-2401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW018325101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103037811Medicaid