Provider Demographics
NPI:1548534571
Name:HAVRILAK, THOMAS (PC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:HAVRILAK
Suffix:
Gender:M
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 N. FRANKLIN DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-5893
Mailing Address - Country:US
Mailing Address - Phone:724-222-2265
Mailing Address - Fax:
Practice Address - Street 1:6 OLIVER PLAZA
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-5893
Practice Address - Country:US
Practice Address - Phone:724-597-4840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA003275101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA003275OtherPROFESSIONAL COUNSELOR