Provider Demographics
NPI:1992839492
Name:NORTHERN TIER COUNSELING, INC
Entity Type:Organization
Organization Name:NORTHERN TIER COUNSELING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:DENAULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-265-0100
Mailing Address - Street 1:24727 ROUTE 6 STE 2
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-8257
Mailing Address - Country:US
Mailing Address - Phone:570-265-0100
Mailing Address - Fax:570-265-6741
Practice Address - Street 1:420 STATE ST
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-8795
Practice Address - Country:US
Practice Address - Phone:570-265-0100
Practice Address - Fax:570-265-6741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA226990261QM0855X
PA225930261QM0855X
PA214940261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000753722OtherHIGHMARK PROV#-PSYCHIATRY
PA753722Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
PA753722Medicare ID - Type UnspecifiedMEDICARE PROVIDER #