Provider Demographics
NPI:1811746340
Name:KATIE'S PLACE CLUBHOUSE
Entity type:Organization
Organization Name:KATIE'S PLACE CLUBHOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WODDER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:570-348-6100
Mailing Address - Street 1:247 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1918
Mailing Address - Country:US
Mailing Address - Phone:272-228-3294
Mailing Address - Fax:
Practice Address - Street 1:247 PENN AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1918
Practice Address - Country:US
Practice Address - Phone:272-228-3294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCRANTON COUNSELING CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)