Healthcare Provider Details

I. General information

NPI: 1164319786
Provider Name (Legal Business Name): MADELYN REILLY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 N BETHLEHEM PIKE STE 203B
AMBLER PA
19002-2186
US

IV. Provider business mailing address

127 GREENWOOD AVE
AMBLER PA
19002-4704
US

V. Phone/Fax

Practice location:
  • Phone: 215-900-3983
  • Fax:
Mailing address:
  • Phone: 215-900-3983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MADELYN B REILLY
Title or Position: OWNER
Credential: LPC
Phone: 215-900-3983