Tiffani Gebhardt
Individual provider Active NPI Professional Counselor · Forty Fort, PA
NPI 1306563374 · NPPES record last updated Oct 20, 2022
Key facts
- NPI
- 1306563374
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- PC014991 (PA)
- Practice address
- 1169 Wyoming Ave
Forty Fort, PA 18704-4003 - Phone
- (570) 904-7363
- Fax
- (570) 348-4079
- NPI assigned
- Oct 20, 2022
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Thaxton Holistic Wellness Center
Practice addresses (Care Compare)
228 S Main Ave
Scranton, PA 18504-2545
Phone (570) 904-7363
254 Daleville Hwy
Covington Township, PA 18444-7951
Phone (570) 904-7363
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240226002694 | PA | Practitioner - Mental Health Counselor | 2567807928 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PC014991 | PA | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thaxton Holistic Wellness Center | Professional | Current |
Accepting new patients |
Locations
1169 Wyoming Ave
Forty Fort, PA 18704
Phone (570) 283-3301
2324 Boulevard Ave
Scranton, PA 18509
Phone (570) 343-2244
228 S Main Ave
Scranton, PA 18504
Phone (570) 468-5191
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | PC014991 | PA | Yes |
Addresses
Primary practice location
1169 Wyoming Ave
Forty Fort, PA 18704-4003
Mailing address
228 S Main Ave
Scranton, PA 18504-2545
Phone (570) 904-7363
Other providers in Forty Fort, PA
- Jeffrey Fremont
- Eric Frusciante
- Kara Furman
- Kathleen Anne Garrity
- Shamus Gartley
- Geisinger Clinic
- Geisinger Wyoming Valley
- Charles Patrick Gelso
- Elizabeth Gernhardt
- Roy Walter Gernhardt III
All providers in Forty Fort, PA · Professional Counselor in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 20, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.