Provider Demographics
NPI:1366109928
Name:CONNECTIONS RELATIONAL THERAPY LLC
Entity type:Organization
Organization Name:CONNECTIONS RELATIONAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIVELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-259-4388
Mailing Address - Street 1:194 STACEY LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8916
Mailing Address - Country:US
Mailing Address - Phone:570-259-4388
Mailing Address - Fax:
Practice Address - Street 1:8 W SNYDER ST STE 2
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-1504
Practice Address - Country:US
Practice Address - Phone:570-259-4388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty