Organization
ITSA PLAYFUL JOURNEY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANNE JEAN MATHIAS MHS, LPC, RPT-S (CHILD AND FAMILY THERAPIST)
(717) 431-2027
Entity
Organization
Contact information
Practice address
2173 EMBASSY DR.,, SUITE 164, LANCASTER, PA 17603
(717) 431-2027
(717) 431-2014
Mailing address
2173 EMBASSY DR.,, SUITE 164, LANCASTER, PA 17603
(717) 431-2027
(717) 431-2014
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
PC003842
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50064527
CAPITAL BLUE CROSS
PA
01
—
MIS220198000
MAGELLAN HEALTH SERVICES
PA
01
—
PC003842
LICENSED PROFESSIONAL
PA
Enumeration date
03/20/2007
Last updated
01/30/2014
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