Provider Demographics
NPI: | 1063483576 |
---|---|
Name: | WESTMONT FAMILY COUNSELING MINISTRIES |
Entity type: | Organization |
Organization Name: | WESTMONT FAMILY COUNSELING MINISTRIES |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | PATRICIA |
Authorized Official - Middle Name: | A |
Authorized Official - Last Name: | HYDOCK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LCSW |
Authorized Official - Phone: | 814-536-0798 |
Mailing Address - Street 1: | 639 LUZERNE ST |
Mailing Address - Street 2: | |
Mailing Address - City: | JOHNSTOWN |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 15905-2327 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 814-536-0798 |
Mailing Address - Fax: | 814-536-5746 |
Practice Address - Street 1: | 639 LUZERNE ST |
Practice Address - Street 2: | |
Practice Address - City: | JOHNSTOWN |
Practice Address - State: | PA |
Practice Address - Zip Code: | 15905-2327 |
Practice Address - Country: | US |
Practice Address - Phone: | 814-536-0798 |
Practice Address - Fax: | 814-536-5746 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-02-01 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |