Provider Demographics
NPI:1669804571
Name:FOOTSTEPS PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:FOOTSTEPS PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:K
Authorized Official - Last Name:HASLETT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:814-266-5238
Mailing Address - Street 1:334 BLOOMFIELD ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3268
Mailing Address - Country:US
Mailing Address - Phone:814-266-5238
Mailing Address - Fax:
Practice Address - Street 1:334 BLOOMFIELD ST
Practice Address - Street 2:SUITE 104
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3268
Practice Address - Country:US
Practice Address - Phone:814-266-5238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-01
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008994L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA331004OtherBLUE CROSS/SHIELD
PA1025765450004Medicaid