Provider Demographics
NPI:1659776094
Name:LIBERTY COUNSELING AND THERAPY
Entity Type:Organization
Organization Name:LIBERTY COUNSELING AND THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:N
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:717-818-4868
Mailing Address - Street 1:313 W LIBERTY ST
Mailing Address - Street 2:SUITE 344
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-2798
Mailing Address - Country:US
Mailing Address - Phone:717-818-4868
Mailing Address - Fax:717-898-2135
Practice Address - Street 1:313 W LIBERTY ST
Practice Address - Street 2:SUITE 344
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2798
Practice Address - Country:US
Practice Address - Phone:717-818-4868
Practice Address - Fax:717-898-2135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW 0160141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1730166570OtherNPI
PACW016014OtherSLWK LICENSE
PA129590LRROtherPTAN
PA11837471OtherCAQH