Provider Demographics
NPI:1861697856
Name:PECOSH, MICHAEL KENNEDY (MED, NCC, LPC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:KENNEDY
Last Name:PECOSH
Suffix:
Gender:M
Credentials:MED, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 OLD PLANK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-9044
Mailing Address - Country:US
Mailing Address - Phone:724-249-2829
Mailing Address - Fax:724-206-9222
Practice Address - Street 1:20 OLD PLANK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-9044
Practice Address - Country:US
Practice Address - Phone:724-249-2829
Practice Address - Fax:724-206-9222
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004605101Y00000X, 101YM0800X, 101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist