Provider Demographics
NPI:1013007830
Name:BRUST, PAULA (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:BRUST
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 ASH ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1505
Mailing Address - Country:US
Mailing Address - Phone:570-969-2510
Mailing Address - Fax:570-383-0663
Practice Address - Street 1:2200 ASH ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1505
Practice Address - Country:US
Practice Address - Phone:570-969-2510
Practice Address - Fax:570-383-0663
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA000482101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA22037OtherNBCC
PA000482OtherLICENSED PROFESSIONAL COU