Provider Demographics
| NPI: | 1770597767 |
|---|---|
| Name: | CONNELLSVILLE COUNSELING CENTER |
| Entity type: | Organization |
| Organization Name: | CONNELLSVILLE COUNSELING CENTER |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PRESIDENT/CEO |
| Authorized Official - Prefix: | MS |
| Authorized Official - First Name: | CAROLE |
| Authorized Official - Middle Name: | GENE |
| Authorized Official - Last Name: | STERN |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | PSYCHOLOGIST |
| Authorized Official - Phone: | 724-626-9941 |
| Mailing Address - Street 1: | 110 S ARCH ST |
| Mailing Address - Street 2: | |
| Mailing Address - City: | CONNELLSVILLE |
| Mailing Address - State: | PA |
| Mailing Address - Zip Code: | 15425-3515 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 724-626-9941 |
| Mailing Address - Fax: | 724-626-2785 |
| Practice Address - Street 1: | 110 S ARCH ST |
| Practice Address - Street 2: | |
| Practice Address - City: | CONNELLSVILLE |
| Practice Address - State: | PA |
| Practice Address - Zip Code: | 15425-3515 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 724-626-9941 |
| Practice Address - Fax: | 724-626-2785 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-07-28 |
| Last Update Date: | 2014-04-22 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 323P00000X, 103T00000X | ||
| PA | 443260 | 261QM0855X, 261QM0850X, 101Y00000X, 261QM0801X, 261QC1500X, 103TM1800X, 2084P0804X, 2084P0800X, 261Q00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | ||
| No | 323P00000X | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | Group - Multi-Specialty | |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | Group - Multi-Specialty |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | Group - Multi-Specialty |
| No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
| No | 261QC1500X | Ambulatory Health Care Facilities | Clinic/Center | Community Health | |
| No | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities | Group - Multi-Specialty |
| No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
