Provider Demographics
NPI:1194030726
Name:ENDLESS MOUNTAINS COUNSELING ASSOCIATES
Entity type:Organization
Organization Name:ENDLESS MOUNTAINS COUNSELING ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.S.
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:SMOTHERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-553-2078
Mailing Address - Street 1:27241 STATE ROUTE 267
Mailing Address - Street 2:
Mailing Address - City:FRIENDSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18818-8640
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27241 STATE ROUTE 267
Practice Address - Street 2:
Practice Address - City:FRIENDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18818-8640
Practice Address - Country:US
Practice Address - Phone:570-553-2078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENDLESS MOUNTAINS COUNSELING ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004970L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty