Healthcare Provider Details

I. General information

NPI: 1720712094
Provider Name (Legal Business Name): AMBLER COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 N SPRING GARDEN ST
AMBLER PA
19002-3414
US

IV. Provider business mailing address

416 N SPRING GARDEN ST
AMBLER PA
19002-3414
US

V. Phone/Fax

Practice location:
  • Phone: 267-664-0734
  • Fax:
Mailing address:
  • Phone:
  • 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 Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EDWARD BRUNTON
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 267-664-0734