Provider Demographics
NPI:1144287301
Name:EMERY BEHAVIORAL HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:EMERY BEHAVIORAL HEALTH SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:EMERY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:570-522-0304
Mailing Address - Street 1:32 WHISPER CREEK DR
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-7770
Mailing Address - Country:US
Mailing Address - Phone:570-522-0304
Mailing Address - Fax:570-522-0475
Practice Address - Street 1:32 WHISPER CREEK DR
Practice Address - Street 2:SUITE 7
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-7770
Practice Address - Country:US
Practice Address - Phone:570-522-0304
Practice Address - Fax:570-522-0475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YP2500X
PACW0153801041C0700X
PASW013397L104100000X
PA101YM0800X
PASW126648104100000X
PASW124503104100000X
PAPS015898103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019581500001Medicaid
PAEM1824598OtherHIGHMARK BLUE SHIELD
PA1019047770002Medicaid
PA1019060380002Medicaid
PA1022694370001Medicaid
PA1015177000001Medicaid
PA106651Medicare ID - Type UnspecifiedHIGHMARK
PA1019581500001Medicaid