Provider Demographics
NPI:1396010807
Name:MARK SHOAF PROFESSIONAL COUNSELING
Entity type:Organization
Organization Name:MARK SHOAF PROFESSIONAL COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROMANELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-387-2455
Mailing Address - Street 1:1380 OLD FREEPORT RD
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-3127
Mailing Address - Country:US
Mailing Address - Phone:412-517-6848
Mailing Address - Fax:
Practice Address - Street 1:1380 OLD FREEPORT RD
Practice Address - Street 2:SUITE 2B
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-3127
Practice Address - Country:US
Practice Address - Phone:412-517-6848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty