Provider Demographics
NPI:1821463944
Name:BRUNO-POEPPERLING, AGATHA TINA (LPC)
Entity type:Individual
Prefix:
First Name:AGATHA
Middle Name:TINA
Last Name:BRUNO-POEPPERLING
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:BLAKELY
Mailing Address - State:PA
Mailing Address - Zip Code:18447-2500
Mailing Address - Country:US
Mailing Address - Phone:570-575-5068
Mailing Address - Fax:
Practice Address - Street 1:240 TERRACE DR
Practice Address - Street 2:
Practice Address - City:BLAKELY
Practice Address - State:PA
Practice Address - Zip Code:18447-2500
Practice Address - Country:US
Practice Address - Phone:570-575-5068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008145101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional