Healthcare Provider Details

I. General information

NPI: 1962982884
Provider Name (Legal Business Name): TERESA MARY PALANK MA, BSL, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 03/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1347 HAUSMAN RD
ALLENTOWN PA
18104-9063
US

IV. Provider business mailing address

915 POWDER MILL RD
BETHLEHEM PA
18017-1926
US

V. Phone/Fax

Practice location:
  • Phone: 610-573-2500
  • Fax: 610-573-2598
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC010245
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH002801
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: