Provider Demographics
NPI:1780069880
Name:GENE N BROSIUS BEHAVIOR ANALYSIS COUNSELING
Entity type:Organization
Organization Name:GENE N BROSIUS BEHAVIOR ANALYSIS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GENE
Authorized Official - Middle Name:NEWTON
Authorized Official - Last Name:BROSIUS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:570-412-3046
Mailing Address - Street 1:31 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:PA
Mailing Address - Zip Code:17847-1217
Mailing Address - Country:US
Mailing Address - Phone:570-412-3046
Mailing Address - Fax:
Practice Address - Street 1:935 ROUTE 522
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-9714
Practice Address - Country:US
Practice Address - Phone:570-412-3046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101992662Medicaid