| Fulton Behavioral Health Services Pc | |
|
214 Peach Orchard Road Mc Connellsburg PA 17233 | |
| (717) 485-6120 | |
| (717) 485-6106 |
| Full Name | Fulton Behavioral Health Services Pc |
|---|---|
| Speciality | Social Worker |
| Location | 214 Peach Orchard Road, Mc Connellsburg, Pennsylvania |
| Authorized Official Name and Position | Elizabeth T. Gotwals (OWNER/ADMINISTRATOR) |
| Authorized Official Contact | 7174856120 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fulton Behavioral Health Services Pc 214 Peach Orchard Road Mc Connellsburg PA 17233 Ph: (717) 485-6120 | Fulton Behavioral Health Services Pc 214 Peach Orchard Road Mc Connellsburg PA 17233 Ph: (717) 485-6120 |
| NPI Number | 1962736934 |
|---|---|
| Provider Enumeration Date | 09/23/2009 |
| Last Update Date | 08/10/2010 |
| Medicare PECOS PAC ID | 2860530714 |
|---|---|
| Medicare Enrollment ID | O20091112000628 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962736934 | NPI | - | NPPES |
| 0018117730001 | Medicaid | PA | |
| 1024376860001 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Secondary |
| 104100000X | Social Worker | (* (Not Available)) | Primary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| Provider Name | Elizabeth Gotwals |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619951183 PECOS PAC ID: 9830285121 Enrollment ID: I20071018000038 |
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