Provider Demographics
NPI:1831211952
Name:NORTHERN TIER COUNSELING, INC
Entity type:Organization
Organization Name:NORTHERN TIER COUNSELING, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:DENAULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-265-0100
Mailing Address - Street 1:24727 ROUTE 6 STE 2
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-8257
Mailing Address - Country:US
Mailing Address - Phone:570-265-0100
Mailing Address - Fax:570-265-6741
Practice Address - Street 1:24727 ROUTE 6 STE 2
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-8257
Practice Address - Country:US
Practice Address - Phone:570-265-0100
Practice Address - Fax:570-265-6741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
803428OtherFP PROV-CHEMICAL RECOVERY
PA753722OtherBLUE CROSS PROVIDER #-D&A
PA753722Medicare PIN