Provider Demographics
NPI:1528480159
Name:GRACEY-YOHN, DARYLE
Entity type:Individual
Prefix:
First Name:DARYLE
Middle Name:
Last Name:GRACEY-YOHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 5TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-1549
Mailing Address - Country:US
Mailing Address - Phone:717-899-0331
Mailing Address - Fax:814-707-4024
Practice Address - Street 1:201 5TH ST STE 203
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-1549
Practice Address - Country:US
Practice Address - Phone:717-899-0331
Practice Address - Fax:814-707-4024
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007889101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor