Provider Demographics
NPI:1649202094
Name:RURAL MENTAL HEALTH ASSOCIATES INC
Entity Type:Organization
Organization Name:RURAL MENTAL HEALTH ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:BOYER
Authorized Official - Last Name:DRELICK
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:814-678-6900
Mailing Address - Street 1:19 CENTRAL AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:OIL CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16301-2733
Mailing Address - Country:US
Mailing Address - Phone:814-678-6900
Mailing Address - Fax:814-678-6902
Practice Address - Street 1:19 CENTRAL AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:OIL CITY
Practice Address - State:PA
Practice Address - Zip Code:16301-2733
Practice Address - Country:US
Practice Address - Phone:814-678-6900
Practice Address - Fax:814-678-6902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003785101YP2500X
PAPC000646101YP2500X
PAPS005971L103TC0700X
PAPS005854L103TC1900X
PASW125709104100000X
PACW0132521041C0700X
PACW0144221041C0700X
PACW0146571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA149920OtherMEDICARE PTAN
PA102198783Medicaid
PA631706OtherBLUE SHIELD
PA666521OtherBLUE SHIELD