NPIMap

Organization Active NPI

Glade Run Lutheran Services

  • Mental Health Counselor
  • Zelienople, PA
National Provider Identifier
1295890002
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
403080 Issued in PA
Legal business name
GLADE RUN LUTHERAN SERVICES
Practice address
Beaver Road
Zelienople, PA 16063-0070
Phone
(724) 452-4453
Fax
(724) 452-6576
NPI assigned
Dec 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Charles T Lockwood
Title
Executive Director
Phone
(724) 452-4453

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X 403080 PA Primary

Addresses

Primary practice location

Beaver Road
Zelienople, PA 16063-0070

Mailing address

PO Box 70
Zelienople, PA 16063-0070
Phone (724) 452-4453

Other identifiers 1

IdentifierTypeStateIssuer
100754254-0003MedicaidPA

National Provider Directory

National Provider Directory
Tax ID family
Glade Run Lutheran Services12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1295890002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70",
            "city": "ZELIENOPLE",
            "state": "PA",
            "postal_code": "160630070",
            "telephone_number": "724-452-4453",
            "fax_number": "724-452-6576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BEAVER ROAD",
            "city": "ZELIENOPLE",
            "state": "PA",
            "postal_code": "160630070",
            "telephone_number": "724-452-4453",
            "fax_number": "724-452-6576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLADE RUN LUTHERAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LOCKWOOD",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "724-452-4453",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "PA",
            "license": "403080",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100754254-0003",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Zelienople, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.