Provider Demographics
NPI:1316923568
Name:CHILDREN'S PARACLETE
Entity type:Organization
Organization Name:CHILDREN'S PARACLETE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BIXLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:814-539-9636
Mailing Address - Street 1:227 FRANKLIN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-1916
Mailing Address - Country:US
Mailing Address - Phone:814-539-9636
Mailing Address - Fax:814-535-4497
Practice Address - Street 1:227 FRANKLIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-1916
Practice Address - Country:US
Practice Address - Phone:814-539-9636
Practice Address - Fax:814-535-4497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001650500-001OtherMEDICAL ASSISTANCE
PABI1783335OtherHIGHMARK BLUE SHIELD PROV