Provider Demographics
NPI:1265122634
Name:FOCHT, MYLA (LPC)
Entity type:Individual
Prefix:MRS
First Name:MYLA
Middle Name:
Last Name:FOCHT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1641 ROUTE 422 E
Mailing Address - Street 2:
Mailing Address - City:FENELTON
Mailing Address - State:PA
Mailing Address - Zip Code:16034-9746
Mailing Address - Country:US
Mailing Address - Phone:719-588-6426
Mailing Address - Fax:
Practice Address - Street 1:1641 ROUTE 422 E
Practice Address - Street 2:
Practice Address - City:FENELTON
Practice Address - State:PA
Practice Address - Zip Code:16034-9746
Practice Address - Country:US
Practice Address - Phone:719-588-6426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC015602101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional