| Organization Name: | THREE RIVERS PSYCHOLOGICAL ASSOCIATES, LLC |
| NPI Number: | 1407230543 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KELLY WALZ (MEMBER) |
| Mailing Address: | 140 Pennsylvania Ave Oakmont |
| State: | PA US |
| Postal Code: | 151391923 |
| Phone Number: | 4125641760 |
| Fax Number: | |
| NPI Enumeration Date: | 07/18/2015 |
| NPI Last Update Date: | 07/18/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC1900X |
| License Number: | PS017662 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Counseling |
| Taxonomy Definition: | |