Provider Demographics
NPI:1649358276
Name:MISCIK, GREGORY PATRICK (NCC, LPC)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:PATRICK
Last Name:MISCIK
Suffix:
Gender:M
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 LIGONIER ST
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-1832
Mailing Address - Country:US
Mailing Address - Phone:724-537-0760
Mailing Address - Fax:724-537-0780
Practice Address - Street 1:1001 LIGONIER ST
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1832
Practice Address - Country:US
Practice Address - Phone:724-537-0760
Practice Address - Fax:724-537-0780
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004110101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health