Healthcare Provider Details

I. General information

NPI: 1023573680
Provider Name (Legal Business Name): BEHAVIOR AND COUNSELING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2019
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MONUMENT RD
BALA CYNWYD PA
19004-1702
US

IV. Provider business mailing address

150 MONUMENT RD STE 207
BALA CYNWYD PA
19004-1725
US

V. Phone/Fax

Practice location:
  • Phone: 215-452-6274
  • Fax:
Mailing address:
  • Phone: 215-452-6274
  • 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 Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL CLEMENTE
Title or Position: BCBA
Credential: BCBA, LBS, LPC
Phone: 215-452-6274