Organization
COUNTY OF CENTRE
Active
Other names
Centre County BSU
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL J WALTZ (ADMINISTRATOR)
(814) 355-6782
Entity
Organization
Contact information
Practice address
420 HOLMES ST, GROUND FLOOR, BELLEFONTE, PA 16823-1401
(814) 355-6782
(814) 355-6985
Mailing address
420 HOLMES ST, GROUND FLOOR, BELLEFONTE, PA 16823-1401
(814) 355-6782
(814) 355-6985
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007296630012
—
PA
Enumeration date
04/30/2007
Last updated
11/08/2010
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