| Odyssey Of The Heart Llc | |
|
187 Honors Ln State College PA 16803-1838 | |
| (484) 802-5250 | |
| Not Available |
| Full Name | Odyssey Of The Heart Llc |
|---|---|
| Speciality | Counselor |
| Location | 187 Honors Ln, State College, Pennsylvania |
| Authorized Official Name and Position | Leslie Sullivan (OWNER) |
| Authorized Official Contact | 4848025250 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Odyssey Of The Heart Llc Po Box 171 Lemont PA 16851-0171 Ph: (484) 802-5250 | Odyssey Of The Heart Llc 187 Honors Ln State College PA 16803-1838 Ph: (484) 802-5250 |
| NPI Number | 1962279091 |
|---|---|
| Provider Enumeration Date | 12/08/2023 |
| Last Update Date | 12/08/2023 |
| Certification Date | 12/08/2023 |
| Medicare PECOS PAC ID | 2668824251 |
|---|---|
| Medicare Enrollment ID | O20240118004635 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962279091 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Leslie Hall Sullivan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1831677434 PECOS PAC ID: 3577915164 Enrollment ID: I20240118004649 |
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