Provider Demographics
NPI:1295058352
Name:INNER VISION TREATMENT SERVICES
Entity type:Organization
Organization Name:INNER VISION TREATMENT SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC,LCAD,CCS,CAC,SAP
Authorized Official - Phone:201-927-8366
Mailing Address - Street 1:586 MAIN ST
Mailing Address - Street 2:SUITE # 9
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-2004
Mailing Address - Country:US
Mailing Address - Phone:570-476-1902
Mailing Address - Fax:570-476-4225
Practice Address - Street 1:586 MAIN ST
Practice Address - Street 2:SUITE # 9
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-2004
Practice Address - Country:US
Practice Address - Phone:570-476-1902
Practice Address - Fax:570-476-4225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00129700101YA0400X
PAPC005016101YP2500X, 103TA0400X
PA457035101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty