Organization
INNOVATIVE THERAPY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANA LYNN BENNETT LCSW (PARTNER)
(814) 240-1011
Entity
Organization
Contact information
Practice address
3939 W RIDGE RD, SUITE B-45, ERIE, PA 16506-1879
(814) 240-1011
(814) 240-1048
Mailing address
3939 W RIDGE RD, SUITE B-45, ERIE, PA 16506-1879
(814) 240-1011
(814) 240-1048
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
PC005212
PA
1041C0700X
Clinical Social Worker
Primary
CW016017
PA
Other
Enumeration date
06/19/2013
Last updated
02/16/2015
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