Provider Demographics
NPI:1669924668
Name:MCCAULEY COUNSELING & SUPPORTIVE SERVICES
Entity type:Organization
Organization Name:MCCAULEY COUNSELING & SUPPORTIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF LLC
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MCCAULEY
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:814-657-7571
Mailing Address - Street 1:3889 STATE ROUTE 417
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:16317-3115
Mailing Address - Country:US
Mailing Address - Phone:814-677-4141
Mailing Address - Fax:814-677-4141
Practice Address - Street 1:3889 STATE ROUTE 417
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:PA
Practice Address - Zip Code:16317-3115
Practice Address - Country:US
Practice Address - Phone:814-677-4141
Practice Address - Fax:814-677-4141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW132411251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health