| NPI | 1366115180 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER M YOUNG Supervisor 570-249-0594 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2021-07-28 |
| Last Update Date | 2021-07-28 |