Provider Demographics
NPI:1497590491
Name:GENA PATACKAS LPC LLC
Entity type:Organization
Organization Name:GENA PATACKAS LPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:EUGENA
Authorized Official - Middle Name:THERESE
Authorized Official - Last Name:PATACKAS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:570-382-3122
Mailing Address - Street 1:1005 MAIN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:PECKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18452-2166
Mailing Address - Country:US
Mailing Address - Phone:570-382-3122
Mailing Address - Fax:
Practice Address - Street 1:1005 MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:PECKVILLE
Practice Address - State:PA
Practice Address - Zip Code:18452-2166
Practice Address - Country:US
Practice Address - Phone:570-382-3122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-01
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)