Organization
LUZERNE INTERMEDIATE UNIT #18
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNIFER LYNN RUNQUIST LPC (DIRECTOR OF BEHAVIORAL HEALTH)
(570) 825-3928
Entity
Organization
Contact information
Practice address
368 TIOGA AVE, KINGSTON, PA 18704-5117
(570) 718-4669
Mailing address
368 TIOGA AVE, KINGSTON, PA 18704-5117
(570) 718-4669
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
217190
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000036690008
—
PA
Enumeration date
02/23/2007
Last updated
08/03/2007
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