Organization
GLADE RUN LUTHERAN SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES T LOCKWOOD (EXECUTIVE DIRECTOR)
(724) 452-4453
Entity
Organization
Contact information
Practice address
BEAVER ROAD, ZELIENOPLE, PA 16063-0070
(724) 452-4453
(724) 452-6576
Mailing address
PO BOX 70, ZELIENOPLE, PA 16063-0070
(724) 452-4453
(724) 452-6576
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
403080
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100754254-0003
—
PA
Enumeration date
12/22/2006
Last updated
08/22/2020
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