Odyssey Of The Heart Llc | |
187 Honors Ln State College PA 16803-1838 | |
(484) 802-5250 | |
Not Available |
Full Name | Odyssey Of The Heart Llc |
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Speciality | Counselor |
Location | 187 Honors Ln, State College, Pennsylvania |
Authorized Official Name and Position | Leslie Sullivan (OWNER) |
Authorized Official Contact | 4848025250 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Odyssey Of The Heart Llc Po Box 171 Lemont PA 16851-0171 Ph: (484) 802-5250 | Odyssey Of The Heart Llc 187 Honors Ln State College PA 16803-1838 Ph: (484) 802-5250 |
NPI Number | 1962279091 |
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Provider Enumeration Date | 12/08/2023 |
Last Update Date | 12/08/2023 |
Certification Date | 12/08/2023 |
Medicare PECOS PAC ID | 2668824251 |
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Medicare Enrollment ID | O20240118004635 |
Identifier | Type | State | Issuer |
---|---|---|---|
1962279091 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
Provider Name | Leslie Hall Sullivan |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1831677434 PECOS PAC ID: 3577915164 Enrollment ID: I20240118004649 |
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