| Divine Interactions Equine Facilitated Wellness, Llc | |
|
1719 Quarry Lane Apollo PA 15613 | |
| (724) 858-7204 | |
| Not Available |
| Full Name | Divine Interactions Equine Facilitated Wellness, Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1719 Quarry Lane, Apollo, Pennsylvania |
| Authorized Official Name and Position | Shanna Aughenbaugh (SOLE MEMBER) |
| Authorized Official Contact | 7248587204 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Divine Interactions Equine Facilitated Wellness, Llc 554 Pleasant View Dr Apollo PA 15613-9225 Ph: () - | Divine Interactions Equine Facilitated Wellness, Llc 1719 Quarry Lane Apollo PA 15613 Ph: (724) 858-7204 |
| NPI Number | 1932697422 |
|---|---|
| Provider Enumeration Date | 04/30/2018 |
| Last Update Date | 04/30/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932697422 | NPI | - | NPPES |
| 1891206850 | Other | PA | LICENSED PROFESSIONAL COUNSELOR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | PC009805 (Pennsylvania) | Primary |