Provider Demographics
NPI:1881728194
Name:NORTHERN TIER COUNSELING, INC
Entity type:Organization
Organization Name:NORTHERN TIER COUNSELING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
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
Mailing Address - Street 2:SUITE 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
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:570-268-2756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA221030261QM0850X
PA201550261Q00000X
PA210160261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000753722OtherHIGHMARK ID#-PSYCHIATRY
PA1007540580103Medicaid
PA753722Medicare PIN
PA1007540580035Medicaid