Basic Information
Provider Information
NPI: 1114987278
EntityType: 2
ReplacementNPI:  
OrganizationName: PENNSYLVANIA COUNSELING SERVICES
LastName:  
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Mailing Information
Address1: 200 NORTH SEVENTH STREET
Address2:  
City: LEBANON
State: PA
PostalCode: 17046
CountryCode: US
TelephoneNumber: 7172731710
FaxNumber: 7172731416
Practice Location
Address1: 200 N 7TH ST
Address2:  
City: LEBANON
State: PA
PostalCode: 170465040
CountryCode: US
TelephoneNumber: 7172731710
FaxNumber: 7172731416
Other Information
ProviderEnumerationDate: 03/24/2006
LastUpdateDate: 06/12/2008
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AuthorizedOfficialLastName: BREWER
AuthorizedOfficialFirstName: DENA
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AuthorizedOfficialTitleorPosition: DIRECTOR OF MANAGED CARE
AuthorizedOfficialTelephone: 7172731710
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialCredential: AA
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

ID Information
IDTypeStateIssuerDescription
10077551205PA MEDICAID


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