Organization
LYCOMING THERAPEUTIC WRAP AROUND SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN S NEIL DR (OWNER)
(570) 322-5051
Entity
Organization
Contact information
Practice address
1521 WASHINGTON BLVD, WILLIAMSPORT, PA 17701-5426
(570) 322-5051
(570) 322-6788
Mailing address
1521 WASHINGTON BLVD, WILLIAMSPORT, PA 17701-5426
(570) 322-5051
(570) 322-6788
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS008553L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1011074990002
—
PA
Enumeration date
01/26/2007
Last updated
07/21/2022
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