Provider Demographics
NPI:1649608530
Name:NORTHEAST COUNSELING SERVICES
Entity type:Organization
Organization Name:NORTHEAST COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC. DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EMERSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:570-735-7590
Mailing Address - Street 1:663 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NANTICOKE
Mailing Address - State:PA
Mailing Address - Zip Code:18634-1825
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1700 W 22ND ST
Practice Address - Street 2:
Practice Address - City:HAZLE TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18202-1535
Practice Address - Country:US
Practice Address - Phone:570-455-6385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-31
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1007615710004261QM0801X, 261QM0850X, 261QM0855X
PA1007615710065261QM0850X, 261QM0855X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007615710073Medicaid
PA1007615710078Medicaid
PA1007615710079Medicaid
PA1007615710081Medicaid
PA1007615710083Medicaid
PA1007615710065Medicaid
PA1007615710074Medicaid
PA1007615710082Medicaid
PA1007615710076Medicaid
PA1007615710077Medicaid
PA1007615710080Medicaid
PA1007615710084Medicaid
PA1007615710075Medicaid