Provider Demographics
NPI:1023432705
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:DENALULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-265-0100
Mailing Address - Street 1:24727 ROUTE 6
Mailing Address - Street 2:SUITE 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 1:8 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:PA
Practice Address - Zip Code:16933-1530
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:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA201550261Q00000X, 261QM0855X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007540580042Medicaid
PA801928OtherFIRST PRIORITY HEALTH-PSYCHIATRY
PACJ9872OtherRAILROAD MEDICARE
PA753722OtherHIGHMARK BLUE SHIELD
801927OtherFPH-SOCIAL WORKER
PA801928OtherFIRST PRIORITY HEALTH-PSYCHIATRY