Provider Demographics
NPI:1760994685
Name:MEADVILLE COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:MEADVILLE COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:HUSELTON
Authorized Official - Suffix:II
Authorized Official - Credentials:MS
Authorized Official - Phone:814-807-1316
Mailing Address - Street 1:9256 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-6466
Mailing Address - Country:US
Mailing Address - Phone:814-807-1316
Mailing Address - Fax:814-336-1156
Practice Address - Street 1:18320 CONNEAUT LAKE RD
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3740
Practice Address - Country:US
Practice Address - Phone:814-807-1316
Practice Address - Fax:814-336-1156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)