Organization
IRENE STACY CMHC
Active
Parent organization
IRENE STACY CMHC
Other names
Family Based Program
Organization subpart
Yes
Provider details
NPI number
Legal business name
IRENE STACY CMHC
Authorized official
ROGER A KELLY LPC (EXECUTIVE DIRECTOR)
(724) 287-0791
Entity
Organization
Contact information
Practice address
112 HILLVUE DRIVE, BUTLER, PA 16001-3498
(724) 287-0791
(724) 287-2730
Mailing address
112 HILLVUE DRIVE, BUTLER, PA 16001-3498
(724) 287-0791
(724) 287-2730
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
457480
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100003515 0069
—
PA
Enumeration date
12/31/2007
Last updated
12/31/2007
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