Provider Demographics
NPI:1891702445
Name:SCENERY PARK PSYCHOLOGY GROUP
Entity Type:Organization
Organization Name:SCENERY PARK PSYCHOLOGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:TOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:814-237-0551
Mailing Address - Street 1:110 REGENT COURT
Mailing Address - Street 2:SUITE 103
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801
Mailing Address - Country:US
Mailing Address - Phone:814-237-0551
Mailing Address - Fax:814-237-0564
Practice Address - Street 1:110 REGENT COURT
Practice Address - Street 2:SUITE 103
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801
Practice Address - Country:US
Practice Address - Phone:814-237-0551
Practice Address - Fax:814-237-0564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA03111100OtherCAPITAL BLUE CROSS
PASC1514369OtherHIGHMARK BLUE SHIELD