Jessica C Prutsman
Individual provider Active NPI Professional Counselor · Elkland, PA
NPI 1811578917 · NPPES record last updated Jan 17, 2024
Key facts
- NPI
- 1811578917
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- PC016293 (PA)
- Practice address
- 103 Forestview Ave
Elkland, PA 16920-1403 - Phone
- (814) 258-5117
- NPI assigned
- Apr 20, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 9
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 |
|---|---|---|---|---|
| I20231128003044 | PA | Practitioner - Mental Health Counselor | 5698123859 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PC016293 | PA | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Penn Comprehensive Health Services | Current |
Accepting new patients | |
| North Penn Comprehensive Health Services | Current | Accepting new patients | |
| North Penn Comprehensive Health Services | Current |
Accepting new patients | |
| North Penn Comprehensive Health Services | Past | Accepting new patients | |
| North Penn Comprehensive Health Services | Past | Accepting new patients | |
| North Penn Comprehensive Health Services | Past | Accepting new patients | |
| North Penn Comprehensive Health Services | Past | Accepting new patients | |
| North Penn Comprehensive Health Services | Past | Accepting new patients | |
| North Penn Comprehensive Health Services | Past | Accepting new patients |
Locations
6 Riverside Plz
Blossburg, PA 16912
Phone (570) 638-2174
103 Forestview Ave
Elkland, PA 16920
Phone (814) 258-5117
32 E Lawrence Rd
Lawrenceville, PA 16929
Phone (570) 827-0125
40 W Wellsboro St
Mansfield, PA 16933
Phone (570) 662-1945
416 S Main St
Mansfield, PA 16933
Phone (570) 662-1900
410 Main St
Ste 102
Towanda, PA 18848
Phone (570) 266-5882
45 Mud Creek Rd
Troy, PA 16947
Phone (570) 297-3746
7 Water St
Wellsboro, PA 16901
Phone (570) 724-1010
236 E Main St
Westfield, PA 16950
Phone (814) 367-5911
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | PC016293 | PA | Yes |
Addresses
Primary practice location
103 Forestview Ave
Elkland, PA 16920-1403
Mailing address
40 W Wellsboro St
Mansfield, PA 16933-1411
Phone (570) 662-1945
Other names
- Miss Jessica C Carr
Other providers in Elkland, PA
- Matthew P Heckman
- North Penn Comprehensive Health Services
- Northern Tioga School District
- Novapharm Enterprises Inc.
- Scott L Pawlak
- Andrei Rudic
- Todd A Rudy
- Brittany Seeley
- Strohecker Vision Care, Inc
- Joseph Alexander White
All providers in Elkland, 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 Jan 17, 2024. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.