Amber Diack Kresovich, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

PC007780 Issued in PA

Practice address

111 S Spring St
Bellefonte, PA 16823

Phone

(814) 933-5335

Fax

(814) 470-8744

NPI assigned

Jun 26, 2007

Last updated

Oct 19, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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

{
    "created_epoch": "1182816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666137600000",
    "number": "1639375512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138 ARCHERS GLEN RD",
            "city": "BELLEFONTE",
            "state": "PA",
            "postal_code": "168236457",
            "telephone_number": "814-571-6620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S SPRING ST",
            "city": "BELLEFONTE",
            "state": "PA",
            "postal_code": "16823",
            "telephone_number": "814-933-5335",
            "fax_number": "814-470-8744"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "190 Match Factory Pl",
            "address_purpose": "LOCATION",
            "city": "Bellefonte",
            "state": "PA",
            "postal_code": "168231367",
            "country_code": "US",
            "telephone_number": "814-353-3151",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KRESOVICH",
        "first_name": "AMBER",
        "middle_name": "DIACK",
        "name_prefix": "Mrs.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-26",
        "last_updated": "2022-10-19",
        "certification_date": "2022-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "PA",
            "license": "PC007780",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LPC LICENSE",
            "identifier": "PC007780",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Bellefonte, PA
• Providers in Bellefonte, PA by specialty
• Professional Counselor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2022; 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.