Basic Information
| Provider Information | |||||||||
| NPI: | 1366534620 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PENNSYLVANIA COUNSELING SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 N 7TH ST. | ||||||||
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| City: | LEBANON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172725464 | ||||||||
| FaxNumber: | 7172731416 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 N 7TH ST. | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172725464 | ||||||||
| FaxNumber: | 7172731416 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 03/24/2015 | ||||||||
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| AuthorizedOfficialLastName: | KIEHL | ||||||||
| AuthorizedOfficialFirstName: | JANELLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | HR SUPPORT STAFF | ||||||||
| AuthorizedOfficialTelephone: | 7172725464 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 251S00000X | N | Agencies | Community/Behavioral Health | 261QM0855X | 316760 | PA | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 100775512 | 05 | PA | MEDICAID |