MEDICARE: ASSOCIATES IN BEHAVIORAL DIAGNOSTICS AND TREATMENT, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist
2	103T00000X	Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659649911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSOCIATES IN BEHAVIORAL DIAGNOSTICS AND TREATMENT, LLC

Provider Business Mailing Address
First Line	:	1150 THORN RUN RD
Second Line	:	SUITE 110
City	:	MOON TWP
State	:	PA
Zip	:	15108-3102
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1150 THORN RUN RD
Second Line	:	SUITE 110
City	:	MOON TWP
State	:	PA
Zip	:	15108-3102
Country	:	US
Telephone Number	:	412-329-7778
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST/OWNER
Name	:	DR. AMANDA PELPHREY
Credential	:	PSYD
Telephone Number	:	412-329-7778

Provider Enumeration Date	:	12/01/2011
Last Update Date	:	04/27/2016

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1150 THORN RUN RD , SUITE 110
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1972844124 — MEGHAN HUERBIN LPC
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1150 THORN RUN RD STE 110
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15108-3102

Practice Phone: 412-329-7778
Practice Fax: 412-262-1555

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1150 THORN RUN RD STE 110
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1194278465 — MARY KATLYN MILLER LPC, NCC
Practice Location Address:

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1568731867 — ASSOCIATES IN BEHAVIORAL DIAGNOSTICS AND TREATMENT, LLC
Practice Location Address:

1150 THORN RUN RD STE 110
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Practice Phone: 412-329-7778
Practice Fax: 412-262-1555

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