Provider Demographics
NPI:1053440958
Name:REGIONAL COUNSELING CENTER, INC.
Entity type:Organization
Organization Name:REGIONAL COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:AYLESWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:814-676-5614
Mailing Address - Street 1:815 GRANDVIEW RD
Mailing Address - Street 2:P.O. BOX 886
Mailing Address - City:OIL CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16301-2077
Mailing Address - Country:US
Mailing Address - Phone:814-676-5614
Mailing Address - Fax:814-677-5760
Practice Address - Street 1:815 GRANDVIEW RD
Practice Address - Street 2:
Practice Address - City:OIL CITY
Practice Address - State:PA
Practice Address - Zip Code:16301-2077
Practice Address - Country:US
Practice Address - Phone:814-676-5614
Practice Address - Fax:814-677-5760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA422710261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000032570011Medicaid