Provider Demographics
NPI:1780898478
Name:VALBURG, MITCHELL (LPC)
Entity type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:
Last Name:VALBURG
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 ASHMORE AVE
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-1562
Mailing Address - Country:US
Mailing Address - Phone:570-877-3140
Mailing Address - Fax:570-253-8242
Practice Address - Street 1:421 S STATE ST
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1684
Practice Address - Country:US
Practice Address - Phone:570-877-3140
Practice Address - Fax:570-253-8242
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA004492101YM0800X, 101YP2500X
PAPC004492106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist