Petkac Psychotherapy Services

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

PETKAC PSYCHOTHERAPY SERVICES

Practice address

4021 W 12TH St
Erie, PA 16505-3354

Phone

(814) 882-3861

Fax

(814) 833-7944

NPI assigned

Jan 9, 2007

Organization subpart

No

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

Authorized official

Name

John S. Petkac, MANPI 1265432843

Title

Owner

Phone

(814) 882-3861

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John S. Petkac, LPC

  • Professional Counselor
  • Erie, PA
  • NPI 1265432843
  NPD (past) Authorized official

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379980800000",
    "number": "1508915463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4021 W 12TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165053354",
            "telephone_number": "814-882-3861",
            "fax_number": "814-833-7944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4021 W 12TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165053354",
            "telephone_number": "814-882-3861",
            "fax_number": "814-833-7944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETKAC PSYCHOTHERAPY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2013-09-24",
        "status": "A",
        "authorized_official_last_name": "PETKAC",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "814-882-3861",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meg Peterson
• Renee Lynn Peterson, O.D.
• Robert Schaefer Peterson, MED
• Ross C Peterson, MD
• Theresa Ann Peterson, LCSW
• John S. Petkac, LPC
• Maryna Petrasheuskaya, DDS
• Megan Claire Petrilla, ATC
• Adam J Petroski, DO
• Dora Petrosyan, MS, OTR/L

• Community/Behavioral Health Agency in Erie, PA
• Providers in Erie, PA by specialty
• Community/Behavioral Health Agency in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2013; 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.